OBJECTIVE - To analyze if prediction of survival for patients with synchronous metastatic renal cell cancer (mRCC) could be further refined by baseline volume of the primary tumor, the metastases, or the remaining volume after surgery; this study was performed because survival expectancies of patients with intermediate-risk mRCC vary substantially.
MATERIAL AND METHODS - The predictive value of the different volumes on overall survival (OS) was analyzed retrospectively in patients with intermediate Memorial Sloan-Kettering Cancer Center (MSKCC) risk profile and ≤3 International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) factors, who received sunitinib in our institute. Tumor volumes were calculated on segmented computed tomography using in-house developed software. A multivariate analysis was performed including number of metastatic sites and baseline tumor burden (TB).
RESULTS - A total of 68 patients were included. Median OS for patients without cytoreductive nephrectomy (CN) was 6 months (95% CI: 3. 0-8. 9mo) vs. 31 months (95% CI: 23. 1-38. 8mo) for those with CN, respectively. More second-line treatment was given after CN (49% vs. 17%, P = 0. 125). There was no correlation between tumor volume and TB measured by Response Evaluation Criteria in Solid Tumors. Of all included clinical and volumetric parameters, remaining volume after CN, CN status and 2 vs. 3 IMDC factors were significantly correlated with OS. In the Cox regression analysis, CN was the only remaining significant parameter (P = 0. 003).
CONCLUSIONS - None of the baseline volumetric parameters is an independent prognostic factor in patients with intermediate MSKCC risk mRCC with≤3 IMDC factors receiving sunitinib. Only CN status correlated significantly with prognosis. None of the baseline volumes nor TB by Response Evaluation Criteria in Solid Tumors was associated with CN status, suggesting that extent of disease had no significant influence on the decision to perform surgery.
Urologic oncology. 2016 Jan 25 [Epub ahead of print]
Roderick E de Bruijn, Jasper Nijkamp, Allard Noe, Simon Horenblas, John B A G Haanen, Warner Prevoo, Axel Bex
Department of Urology, Sint Lucas Andreas Hospital, Amsterdam, The Netherlands. Department of Radiotherapy, The Netherlands Cancer Institute, Amsterdam, The Netherlands. , Department of Urology, Sint Antonius Hospital, Nieuwegein, The Netherlands. , Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands. , Department of Medical Oncology, The Netherlands Cancer Institute Amsterdam, The Netherlands. , Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands. , Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.