1900P - Role of cytoreductive nephrectomy (CN) in metastatic clear cell renal cell carcinoma (mccRCC) in the era of immunotherapy (IO): An analysis of the national cancer database (2004-2020)

Background

The effectiveness of CN is still uncertain despite two significant trials, SURTIME and CARMENA, which aimed to demonstrate its benefits for mccRCC. These trials, conducted with Sunitinib as the standard treatment, did not provide evidence supporting the use of CN.

Methods

We identified stage IV mccRCC only patients (pts) who received IO with or without surgery in the NCDB 2004-2020. Overall survival (OS) was calculated among three groups of IO alone (group (gr)1), IO followed by CN (gr2), CN followed by IO (gr3). Cox models compared OS by treatment group after adjusting for sociodemographic, health, and facility variables.

Results

From 1,549,101 renal cancer cases, 7,367 met our criteria. 2.8% of ccRCC had sarcomatoid histology. Pts in the gr 2 and gr 3 had 63%, 95% CI [0.304 - 0.460] and 47%, 95% CI [0.492-0.571] (P= 0.001) risk reduction in mortality compared to gr 1.Black race compared to white race, Medicare pts compared to privately insured, and pts treated at a comprehensive community cancer center compared to academic center had an increased mortality risk by 15%, 95% CI [1.025-1.290] (P= 0.017), 12%, 95% CI [1.017-1.242] (P= 0.021), 17%, 95% CI [1.092-1.260] (P= 0.001) respectively. Median income quartiles ranging > 63k, had 22% reduction in mortality over income quartiles < 40k, 95% CI [0.696-0.888] (P= 0.044). Regardless of the sequence of CN, partial nephrectomy was minimally used. Pts in gr 3 had a 40% increased mortality risk compared to pts in gr 3, 95% CI [1.126-1.735] (P= 0.002).

Conclusions

Pts receiving CN regardless of sequence with IO did better than IO alone in this national registry-based adjusted analysis for mccRCC. Over the past few decades, the understanding of the role of CN has undergone changes, and while we await additional trial outcomes, the current evidence supports the notion that select mRCC patients can benefit from CN.

Table: 1900P

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.