CUA 2018: Outcomes of Metastasectomy in Metastatic Renal Cell Carcinoma Patients: The Canadian Kidney Cancer Information System Experience

Halifax, Nova Scotia ( In common urological practices, it has been shown that over 25% of patients are diagnosed with metastasis at the time of renal cell carcinoma (RCC) diagnosis and up to 35% will eventually progress to metastasis after some time. There have been recent indications that state that surgical resection of these metastatic tumors can be integrated into the treatment plan with the possibility of slowed disease progression and increased survival. Sara Nazha, MD of McGill University determined to discover the efficacy of this treatment by conducting a multi-center retrospective study to assess the impact of metastasectomy in patients suffering from metastatic RCC (mRCC). 

To determine an answer to this research question, the Canada Kidney Cancer information service (CKCis) was used to pool data from 9 different centers throughout Canada. Patients were screened for a diagnosis of mRCC with a pathologic confirmation of RCC between January 2011 and December 2017. Patients were stratified by whether they had received a metastasectomy (complete or incomplete) or not received metastasectomy. Each patient who underwent metastasectomy was matched with up to 10 patients with no metastasectomy in regard to age, clear cell histology, use of targeted therapy prior to metastasectomy, or having a nephrectomy. Overall survival was defined as the death of any kind from the initial diagnosis of mRCC. 

Following study completion, it was determined that 329 patients had complete (221 pts) or incomplete (108 pts) metastasectomy for mRCC, respectively, while 1,347 mRCC patients did not undergo metastasectomy. The main endpoint of the study showed that patients who underwent a metastasectomy were associated with a significantly increased survival rate compared to no metastasectomy. When comparing complete versus incomplete metastasectomy cohorts, and additional significant increase in overall survival was seen, in the favor of complete metastasectomy. Kaplan-Meier curves depicting both of these statistics are shown below. 
UroToday CUA 2018 Outcomes of Metastasectomy in Metastatic Renal Cell Carcinoma Patients 1

UroToday CUA 2018 Outcomes of Metastasectomy in Metastatic Renal Cell Carcinoma Patients 2
In her closing remarks, Nazha reiterated how the metastasectomy treatments modality is capable of yielding longer overall survival in patients afflicted by mRCC. She urged the audience to please consider this treatment whenever a patient presents with this condition as it has shown to be vastly better than non-metastasectomy treatments. 

Presented by: Sara Nazha, McGill University Health Centre, McGill University, Montreal, QC, Canada
Co-Authors: Alice Dragomir1, Antonio Finelli2, Aaron Hansen2, Lori Wood3, Ricardo Rendon3, Alan So4, Christian Kollmannsberger4, Frédéric Pouliot5, Naveen Basappa6, Daniel Heng7, Denis Soulières8, Anil Kapoor9, Simon Tanguay1.

Author Information:
1. McGill University Health Centre, McGill University, Montreal, QC, Canada
2. Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
3. Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
4. BC Cancer Agency Vancouver Cancer Centre, BC Cancer Agency, Vancouver , BC, Canada
5. Centre Hospitalier Universitaire de Québec, University of Laval, Quebec, QC, Canada
6. Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
7. Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
8. Centre Hospitalier de l’Université de Montréal, University of Montreal, Montreal, QC, Canada
9. Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada

Written By: Zachary Valley Twitter: @ZacharyAValley, (Department of Urology, University of California-Irvine) medical writer for at the 73rd Canadian Urological Association Annual Meeting - June 23 - 26, 2018 - Halifax, Nova Scotia