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67th Annual Meeting Abstracts
Utilization of Systemic Therapy and Factors Impacting Survival in Patients Undergoing Cytoreductive Nephrectomy
Alexander Kutikov1, Robert G. Uzzo1, Aaron Caraway2, Carl T. Reese2, Brian L. Egleston1, David Y.T. Chen1, Rosalia Viterbo1, Richard E. Greenberg1, Yu-Ning Wong1, Jay D. Raman2, Stephen A. Boorjian1
1Fox Chase Cancer Center, Philadelphia, PA;2Penn State Milton S. Hershey Medical Center, Hershey, PA
Introduction:
A survival benefit to cytoreductive nephrectomy (CN) in patients with metastatic renal cell carcinoma (RCC) treated with immunotherapy has been demonstrated, and these data have been extrapolated to support CN in the targeted therapy era as well. Nevertheless, the likelihood that patients undergoing CN will receive systemic treatment remains poorly defined. Here, we present a multi-institutional experience evaluating the utilization of systemic therapy in patients undergoing CN.
Materials & Methods:
141 patients who underwent CN between 1990 and 2008 were identified from our Institutional Kidney Cancer Registries. Kaplan Meier analyses and Cox regression models were used to assess the impact of clinicopathological variables on utilization of systemic therapy and survival.
Results:
Overall, 98 patients (69.5%) received systemic therapy, at a median of 2.5 months (range 0.1-61.5) after CN. In this group, 52 (53%) patients received immunotherapy, 34 (35%) targeted agents, and 12 (12%) other regimens. By contrast, 43 patients (30.5%) did not receive systemic therapy, because of rapid disease progression (n=13, 30%), decision for surveillance (n=9, 21%), patient refusal (n=10, 23%), perioperative death (n=8, 19%), and unknown reasons (n=3, 7.0%). Median survival after CN was 16.7 months (range 0-120). The risk of death after CN correlated with symptoms at presentation (p=0.006), performance status (p=0.001), tumor grade (p=0.006), number of metastatic sites (p=0.012), and sarcomatoid histology (p<0.001).
Conclusions:
Nearly 1/3 of patients undergoing CN never received systemic treatment. Studies are needed to identify those patients at highest risk for rapid disease progression who might benefit from a neoadjuvant treatment approach.
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