AUA 2018: Predictors of Recurrence and Survival in Patients with Metastatic Renal Cell Carcinoma Undergoing Complete Surgical Resection

San Francisco, CA ( Complete surgical excision of local lymph node or distant metastases in conjunction with nephrectomy is recommended for metastatic renal cell carcinoma (mRCC) patients. Predictors of recurrence or overall survival (OS) have rarely been described in this unique population. In this study, the goal was to evaluate risk factors associated with RCC recurrence and OS in mRCC patients undergoing nephrectomy with concurrent metastasectomy.

Data was analyzed for consecutive mRCC patients undergoing complete surgical excision of synchronous disease at the time of nephrectomy at 4 independent centers from 2000-2016. Univariate/multivariate Cox proportional hazard models were performed to evaluate associations of clinical and pathological variables with recurrence or OS. Variables evaluated included: gender, race, Karnofsky PS, primary tumor features (grade, T stage, thrombus, diameter, RCC subtype, necrosis, sarcomatoid/rhabdoid features, fat invasion, margin status), preoperative serum labs (hemoglobin, albumin, LDH, calcium), N stage, and M stage.

A total of 236 patients were identified including 67 N+M0, 37 M+N+, and 118 N0M+. Median age at surgery was 61 (IQR 54, 69) and 74% of patients were male. Median follow-up interval was 50.4 months (IQR 13.2, 85.2), and median tumor diameter was 10 cm. RCC recurrence was identified in 144 (64.9%) patients at a median of 15.6 months (IQR 13, 85) following surgery. Multivariable analysis demonstrated that compared to N+M0 patients (referent), N+M+ patients had the highest recurrence risk HR 9.27 (95% CI 3.58, 24.04) followed by N0M+ patients HR 4.33 (95% CI 2.15, 8.73). Tumor thrombus was also an independent predictor of recurrence HR 1.67 (95% CI 1.01, 2.74). A total of 111 (47%) patients died during follow-up with a median OS for all patients of 4.2 years (IQR 2.67-5.6). Independent predictors of OS included: low serum albumin HR 1.91 (95% CI 1.08, 3.4) and N+ M+ patients HR 3.64 (95% CI 1.59, 8.34). No difference in OS was identified in OS between N+M0 and N0M+ patients (p=0.30). Median OS was 6 (3.6,11.9) months for M+N+ patients with low albumin compared to 76 months (30, 135.6) for N+M0/N0M+ patients with normal albumin, as the figure demonstrates.

In conclusion, patients with mRCC have a high risk of recurrence following complete surgical resection. Clearly, low serum albumin and N+M+ have been shown to be risk factors for poor OS following surgery.

Presented by: Daniel Shapiro, MD, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
Co-Authors: Madison, WI, Viraj Master, Atlanta, GA, Jay D. Raman, Hershey, PA, Nirmish Singla, Vitaly Margulis, Connie Wang, Patrick Roberts, Dallas, TX, Wilson Chan, Hershey, PA, Dattatraya Patil, Atlanta, GA, Glenn O. Allen, E. Jason Abel, Madison, WI

Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre @GoldbergHanan at the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA