Survival of metastatic renal cell carcinoma patients continues to improve over time, even in targeted therapy era

To examine the effect of diagnosis year, defined as contemporary (2010-2014), intermediate (2006-2009) and historical (2001-2005) on cancer-specific mortality (CSM) in patients with metastatic renal cell carcinoma (mRCC).

Within Surveillance, Epidemiology, and End Results registry (2001-2014), we identified patients with mRCC. Cumulative incidence and competing risks regression (CRR) models examined CSM, after accounting for other-cause mortality. Finally, we performed subgroup analyses according to histological subtype: clear-cell mRCC (ccmRCC) versus non-ccmRCC.

We identified 15,444 patients with mRCC. Of those, 41.0, 28.7 and 30.3% were diagnosed, respectively, in the contemporary, intermediate and historical years. Of all, 47.1, 5.3 and 47.6% were, respectively, ccmRCC, non-ccmRCC and other mRCC histological variants [sarcomatoid mRCC, cyst-associated mRCC, collecting duct carcinoma and mRCC not otherwise specified (NOS)]. Overall, 24-month CSM rates were, respectively, 61.0, 63.7 and 67.3% in contemporary, intermediate and historical patients. In all patients, multivariable CRR models exhibited higher CSM in intermediate (HR 1.11; p < 0.001) and historical patients (HR 1.24; p < 0.001) than in contemporary patients. Multivariable CRR models focusing on ccmRCC yielded virtually the same results. However, multivariable CRR models focusing on non-ccmRCC showed no CSM differences according to diagnosis year (all p ≥ 0.3).

The introduction of new therapeutic agents resulted in CSM-free survival improvement over study time. However, this effect exclusively applies to patients with ccmRCC, but not to those with non-ccmRCC. This observation is in agreement with established efficacy of systemic therapies for ccmRCC, but lesser efficacy of these agents for non-ccmRCC.

International urology and nephrology. 2017 Sep 20 [Epub ahead of print]

Michele Marchioni, Marco Bandini, Raisa S Pompe, Zhe Tian, Tristan Martel, Anil Kapoor, Luca Cindolo, Francesco Berardinelli, Alberto Briganti, Shahrokh F Shariat, Luigi Schips, Pierre I Karakiewicz

Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada. ., Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada., Division of Urology, McMaster University, Hamilton, ON, Canada., Department of Urology, ASL Abruzzo 2, Chieti, Italy., Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy., Department of Urology, Medical University of Vienna, Vienna, Austria.