AUA 2022: Outcomes of Cytoreductive Nephrectomy Followed by Active Surveillance in Metastatic Renal Cell Carcinoma

(UroToday.com) The 2022 Annual Meeting of the American Urological Association was host to a podium session for advanced kidney cancer. Dr. Sari Khaleel presented his team’s work evaluating outcomes of cytoreductive nephrectomy (CN) followed by active surveillance (AS) in metastatic renal cell carcinoma (RCC).

Dr. Khaleel began his presentation by noting that the role of CN in the contemporary management of metastatic RCC remains controversial. Systemic therapies for metastatic RCC are not without significant adverse events, and CN followed by AS remains a valid management option for select favorable-risk patients (NCCN 2.2022). In 2016, Rini et al. evaluated a cohort of men with treatment-naïve, metastatic, and median time on AS of 14.9 months. Predictors of longer AS period (systemic therapy-free survival) included <=1 IMDC risk factor and <=2 metastatic organ sites.1

The aim of this current study was to determine the intervention-free survival in 97 systemic-therapy-naïve metastatic RCC patients undergoing CN followed by AS (August 1989-January 2020). Secondary outcomes included CSS and OS.

Compared to patients undergoing CN followed by systemic therapy, CN + AS patients were significantly younger, had smaller masses, were less likely to have sarcomatoid features, and lower metastatic volume.

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The median follow up was 31.8 months. The median intervention-free survival was 11.6 months, CSS 53.7 months and OS 52.4 months. The 1- and 2-year intervention-free survival rates were 48.7% and 32.2%. When the “Rini Category” is applied to this data, it clearly predicts intervention-free survival, CSS and OS.

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On univariable cox regression analysis, other predictors of:

  • Intervention-free survival: Bone mets (HR: 2.1, p=0.01) and Rini IMDC score (<=1 risk factor: HR 1.8, p=0.02)
  • CSS: Size of primary (HR 1.1, p=0.03) and sarcomatoid histology (HR 2.4, p-0.03), but not IMDC group or Rini group subcomponents

Dr. Khaleel concluded that:

  • CN + AS remains a reasonable alternative to immediate systemic therapy for select metastatic RCC patients
    • Emphasize the importance of patient selection
    • Median intervention-free survival: 11.6 months (1-year intervention free survival of 32.2%)
    • 2-year OS and CSS: 82.9% and 85%, respectively


Presented by: Sari S. Khaleel, MD, SUO Fellow, Memorial Sloan Kettering Cancer Center, New York, NY

Written by: Rashid Sayyid, MD, MSc – Urology Chief Resident, Augusta University/Medical College of Georgia, @rksayyid on Twitter during the 2022 American Urological Association (AUA) Annual Meeting, New Orleans, LA, Fri, May 13 – Mon, May 16, 2022. 

 Reference:

  1. Rini BI, Dorff TB, Elson P, et al. Active surveillance in metastatic renal-cell carcinoma: a prospective, phase 2 trial. Lancet Oncol. 2016;17(9):1317-24.
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