Survival After Surgery for Renal Cell Carcinoma Metastatic to the Spine: Impact of Modern Systemic Therapies on Outcomes
Ganesh M. ShankarLaura A. Van BeaverBryan D. ChoiMuhamed HadzipasicAhilan SivaganesanAditya V. KarhadeMarco FerroneMitchel B. HarrisAndrew J. SchoenfeldPeter M. SadowKevin OhJoseph H. SchwabPhilip J. SaylorJohn H. Shin
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Modern medical management of metastatic renal cell carcinoma (RCC) includes therapies targeting tyrosine kinases, growth pathways (mammalian target of rapamycin (mTOR)), and immune checkpoints.To test our hypothesis that patients with spinal metastases would benefit from postoperative systemic therapy despite presenting with disease that, in many cases, was resistant to prior systemic therapy.This is an Institutional Review Board-approved clinical retrospective cohort analysis. A sample of adult patients with RCC metastatic to the spine who underwent operative intervention between January 2010 and December 2017 at 2 large academic medical centers was used in this study.We identified 78 patients with metastatic RCC in whom instrumented stabilization was performed in 79% and postoperative stereotactic radiosurgery was performed in 41% of patients. Of patients presenting with weakness or myelopathy, 93% noted postoperative improvement and 78% reported improvement in radicular and axial paraspinal pain severity. Increased overall survival (OS) (913 d (95% CI: 633-1975 d, n = 49) vs 222 d (95% CI: 143-1005 d, n = 29), P = .003) following surgery was noted in patients who received postoperative systemic therapy a median of 80 d (interquartile range 48-227 d) following the surgical intervention.Postoperative outcomes and palliation of symptoms for metastatic RCC without targeted therapies in this cohort are similar to those reported in earlier series prior to the adoption of these systemic therapies. We observed a significantly longer OS among patients who received modern systemic therapies postoperatively. These findings have implications for the preoperative evaluation of patients with systemic disease who may have been deemed poor surgical candidates prior to the availability of these systemic therapies.Keywords:
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You have accessJournal of UrologyScience & Technology Posters1 Apr 2016S&T-22 PROGNOSTIC SIGNIFICANCE OF NEPHRECTOMY IN PATIENTS WITH METASTATIC RENAL CELL CARCINOMA TREATED WITH FIRST-LINE SYSTEMIC THERAPY: A 10-YEAR RETROSPECTIVE ANALYSIS ACCORDING TO MSKCC AND HENG RISK CRITERIA Sung Han Kim, Jae Young Joung, Jinsoo Chung, Kang Hyun Lee, Ho Kyung Seo, and Whi-An Kwon Sung Han KimSung Han Kim More articles by this author , Jae Young JoungJae Young Joung More articles by this author , Jinsoo ChungJinsoo Chung More articles by this author , Kang Hyun LeeKang Hyun Lee More articles by this author , Ho Kyung SeoHo Kyung Seo More articles by this author , and Whi-An KwonWhi-An Kwon More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2851AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The standard therapy for metastatic renal cell carcinoma (mRCC) has changed from immunotherapy (IT) to targeted therapy (TT). Nephrectomy (Nx) is an important treatment and affects mRCC prognosis. This study compared progression–free survival (PFS) and overall survival (OS) between Nx and non-Nx groups according to MSKCC and Heng prognostic risk groups in mRCC patients treated with either IT or TT as first-line systemic therapy. METHODS Between 2004 and 2015, a total of 262 mRCC patients treated with first-line systemic therapy of either TT (N=127, 48.5%) or IT (N=135, 51.5%) were retrospectively analyzed for statistical differences in PFS and OS between 168 (64.1%) Nx and 94 non-Nx patients according to MSKCC (favorable [n=21], intermediate [n=102], poor [n=44]) risk and Heng (40, 157, 40) risk criteria (p < 0.5). This study analyzed progression-free survival (PFS) and overall survival (OS) in mRCC patients according to MSKCC and Heng risk groups treated nephrectomy and non-nephrectomy and with different treatments utilizing systemic agents. RESULTS Among 262 patients, PFS and OS of the Nx and non-Nx groups were significantly different with 8.8 vs. 4.7 months and 28.4 vs. 6.6 months, respectively (p < 0.05). IT and TT group sub-analysis showed that Nx was significantly better for PFS than non-Nx (IT group, 6.9 vs. 2.2 mos; TT group, 11.1 vs. 5.8 mos) and had a better OS (IT, 29.8 vs. 6.5 mos; TT, 27.7 vs. 6.9 mos) (p < 0.001). In MSKCC risk groups, the significance of improved PFS in a poor risk group (13.3 vs. 2.4 mos) and OS in an intermediate risk group (6.0 vs. 4.7 mos) was observed in the Nx group (p < 0.05), with no significant differences in the favorable group between Nx and non-Nx groups (p > 0.05). In the Heng risk group, Nx had insignificantly better PFS than the non–on he Henfor favorable (12.2 vs. 5.8 mos) and intermediate risk (8.4 vs. 5.6 mos) groups, whereas the poor risk group in Nx had an insignificantly similar PFS to the non-Nx group (4.1 vs. 4.3 mos, p > 0.05). However for OS, Nx had significantly better OS than the non-Nx group in favorable (42.1 vs. 5.9 mos) and intermediate groups (24.1 vs. 7.3 mos) (p < 0.05), whereas the poor risk group had insignificantly worse OS than the non-Nx group (5.9 vs. 6.3 mos) (p > 0.05). In IT and the TT group sub-analysis, Nx patients had better PFS and OS in the favorable and the intermediate risk groups for both the MSKCC and Heng models than non-Nx patients, whereas the poor risk group showed PFS and OS similar to or insignificantly worse than the non-Nx group (p > 0.05). CONCLUSIONS The prognostic significance of Nx on PFS and OS according to MSKCC and Heng criteria showed a positive effect on favorable and intermediate risk groups, but a negative effect on poor risk groups, especially for OS in mRCC patients treated with first-line systemic therapies. Further studies are necessary to analyze the efficacy of Nx in a poor risk group. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e317 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Sung Han Kim More articles by this author Jae Young Joung More articles by this author Jinsoo Chung More articles by this author Kang Hyun Lee More articles by this author Ho Kyung Seo More articles by this author Whi-An Kwon More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...
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A kidney tumor is an abnormal growth within the kidney that usually occurs over a period of a time. Each tumor has its own characteristics and it is important to know what tumor the patient has so that the proper treatment can be administered. Kidney tumors can be benign or malignant. Symptoms of all types of kidney tumors are very similar and unspecific. The aims of study: a) To determine how many patients, who were clinically and radiologically diagnosed with kidney tumor, after surgical intervention, have histopathologicaly confirmed renal cell carcinoma; b) To compare number of female and male patients have histopathologicaly confirmed renal cell carcinoma; c) To compare numbers of patients with renal cell carcinoma who are older than 50 years with the ones who are younger than 50 years; d) To determine the most common risk factors for renal cell carcinoma; e) To determine the most common symptoms of renal cell carcinoma; f) To determine what was the most common stage of kidney cancer in the time when it was histopathologicaly confirmed.This study was observational, descriptive, retrospective study of renal cell carcinoma. The study consisted of 28 patients who were clinically and radiologically diagnosed with kidney tumor, which was surgically removed and histopathologicaly tested. All patients were surgically treated at the Urological Clinic of Clinical Centre University of Sarajevo from 1/1/2012 to 06/30/.2012.from 28 patients with a kidney tumor 26 had RCC, the most of patients with RCC were older than 50 years (22 patients), there was 7 female and 19 male patients, the most common symptom was pain (10 patients), the most common risk factor, excluding age, was hypertension (11 patients), patients with RCC was usually diagnosed stage 4 Fuhrman (11 patients).Doctors should give their intention to discover early symptoms of renal cell carcinoma and to do preventive exams and tests in the population of patients who have one or more risk factors for developing this disease. Early diagnose and appropriate therapy could reduce mortality and morbidity of the patients with renal cell carcinoma, and could also reduce costs of treatment.
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We compared progression-free survival (PFS) and overall survival (OS) among 292 metastatic renal cell carcinoma (mRCC) patients either undergoing nephrectomy (Nx, 61.6%) or not (non-Nx, 38.4%), stratified according to the MSKCC and Heng risk models, treated with either immunotherapy (IT, 45.2%) or targeted therapy (TT, 54.8%) between 2000 and 2015. During the follow-up duration of 16.6 months, PFS/OS of the Nx (6.0/30 months) and non-Nx (3.0/6.0 months) groups were significantly different despite differences among baseline parameters (p < 0.05). The intermediate- and poor-risk patients defined using either model showed significantly longer PFS and OS in the Nx group than in the non-Nx group (p < 0.05). After stratifying groups by systemic therapy and risk models, both the Nx and non-Nx groups showed no significant differences in intermediate and poor-risk models (p > 0.05). In both synchronous and metachronous mRCC patients, both PFS and OS showed similar survivals; the Nx group had significantly longer PFS and OS than the non-Nx group, even after considering each systemic therapy and prognostic model. Nx showed a significant positive benefit in PFS and OS compared to no Nx upon patient stratification according to the MSKCC and Heng risk models. The metastatic type did not significantly affect survival between the two groups.
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Between the end of 2005 and the beginning of 2006, several new target therapies have been introduced for the treatment of renal cell carcinoma. In this review, we aimed to explore and summarize the main findings of the use of systemic treatment and its effect on surgery in patients with renal cell carcinoma. We identified three different settings: neoadjuvant and adjuvant settings as well as the association of systemic therapy with surgery in the metastatic renal cell carcinoma patients. Neoadjuvant target therapy with tyrosine kinase inhibitor may facilitate the tumor resection and reduce the overall tumor diameter and its complexity. However, most of the evidence is from small phase I or II clinical trials and results are often conflicting without determining a relevant change in the main parameters investigated, such as tumor complexity. In the adjuvant setting, results from pivotal trials investigating the use of tyrosine kinase inhibitors for patients with non-metastatic RCC treated with surgery discourage this practice. Indeed, most of the evidence from single clinical trials and pooled results from meta-analysis failed to find a survival advantage with the use of adjuvant systemic treatment. To date, an improvement of clinical outcomes after systemic targeted therapies could be only found in the setting of cytoreductive nephrectomy. However, the CARMENA and SURTIME trials recently confirmed the evidence against a surgical treatment in patients with mRCC and poor prognosis. In the near future, significant changes may be introduced by the use of immunotherapies.
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Summary Kidney cancer accounts for 5% and 3% of all adult malignancies in men and women. Renal cell carcinoma (RCC) accounts for approximately 80% of all kidney cancer. This year’s American Society of Clinical Oncology (ASCO) Annual Meeting was held from 2–6 June 2023, in Chicago, USA. Combination therapies for advanced RCC continue to be of interest at ASCO 2023, with the presentation of updated results from some ongoing studies. There were several studies presented at ASCO looking at treatments for non clear renal cell carcinoma. Immunotherapy- based therapy regimes are now the gold standard for rare histological subtypes of RCC.
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