AUA 2018: Does Tumor Size at the Time of Cytoreductive Nephrectomy Influence Survival?

San Francisco, CA USA ( Renzo DiNatale, MD, from Memorial Sloan Kettering Cancer Center presented his groups multi-institutional research focusing on the management of metastatic renal cell carcinoma. Although the cancer has metastasized, patients often undergo a cytoreductive nephrectomy (CN) to improve their quality of life and survival outcomes. However, urologists struggle to select the appropriate patient for the procedure as there are no clear-cut guidelines.

Dr. DiNatale and his colleagues performed a retrospective chart review and after exclusion identified 680 patients with metastatic RCC from 1989-2016 that underwent either a curative nephrectomy (n=308) or CN (n=372). Patients that developed metastases within 90-days after the surgery were included in the CN group. Their primary focus was to identify factors that influence survival rates after surgery. In their analysis they included patient demographics, number of metastatic sites, type of surgery (partial vs. radical), use of targeted therapy, and tumor size, stage, histology and final pathology.

They identified that CN, primary tumor size less than 4 cm, clear cell histology and Fuhrman grade were predictors of survival. Furthermore, they identified that patients that underwent CN and had a tumor size equal to or less than 4 cm had better overall survival compared to those with a primary tumor burden greater than 4cm.

Dr. DiNatale summarized that a primary tumor size equal to or less than 4 cm in patients undergoing CN is a favorable survival outcome, but a larger patient population is needed to evaluate this and the other variables. He concluded that identifying important survival outcomes will lay the foundation for developing guidelines to assist urologists in selecting the appropriate patients for CN.

Presented by: Renzo DiNatale, MD

Written by: Egor Parkhomenko, Department of Urology, University of California-Irvine at the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA