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Tumor Size Reduction and Survival Outcomes in Metastatic Renal Cell Carcinoma

By: Gavin Calabretta, BS
Posted: Thursday, November 18, 2021

A retrospective study recently published in Urologic Oncology: Seminars and Original Investigations found that primary or metastatic tumor reduction of at least 10% following deferred cytoreductive nephrectomy may be associated with better survival outcomes in patients with metastatic clear cell renal cell carcinoma. For this study, Jose A. Karam, MD, of The University of Texas MD Anderson Cancer Center, Houston, and colleagues analyzed three different systemic therapy regimens before deferred cytoreductive nephrectomy: targeted molecular therapy (TMT), immunotherapy, and TMT coupled with immunotherapy.

“In patients with metastatic clear cell renal cell carcinoma, preoperative immunotherapy, TMT, and immunotherapy combined with TMT resulted in comparable tumor responses,” the study authors commented. “Tumor shrinkage of at least 10% after preoperative therapy was associated with better overall survival outcomes in patients who underwent deferred cytoreductive nephrectomy independent of the number and locations of metastases.”

The study enrolled 198 patients, focusing on individual patient data including age, sex, race, and International Metastatic Database Consortium (IDMC) score. Details on pathologic features, including clear cell histology, tumor stage, and number and location of metastases, were also collected through a direct chart review. In addition, tumor diameters were measured with cross-sectional images, and patients were stratified by at least 10% of tumor shrinkage.

Totally, 31.3% of patients had metastatic tumor shrinkage alone, 8.1% had primary tumor shrinkage alone, and 28.3% had both primary and metastatic tumor shrinkage. IDMC scores and median overall survival were similar across patients receiving any of the three preoperative treatment regimens (all P ≥ .80). Still, patients with intermediate-risk IDMC scores had significantly longer median overall survival than patients with poor scores. Lastly, regardless of preoperative therapy, shrinkage of at least 10% of the primary tumor, metastases, or both was associated with better overall survival (hazard ratio [HR] = 0.48, 95% confidence interval [CI] = 0.32−0.73; HR = 0.48, 95% CI = 0.23−0.98; HR = 0.44, 95% CI = 0.29−0.67, respectively).

Disclosure: For full disclosures of the study authors, visit sciencedirect.com.



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