Rutgers Robert Wood Johnson Medical School New Brunswick, New Jersey, United States
Background: The advent of immunotherapy (IO) agents has led to a paradigm shift in the treatment of stage 4 renal cancer. The role of cytoreductive nephrectomy is unclear since trials demonstrating survival benefit were performed prior to the use of IO therapy. We aimed to determine if overall survival (OS) of stage 4 renal cancer patients treated with IO differed if nephrectomy was performed.
Methods: The Oncology Research Information Exchange Network (ORIEN) Avatar Database collected clinical data from ten United States cancer centers. Of 1,035 patients receiving IO for various cancers, 84 patients with stage 4 renal cancer were identified. Patient characteristics and comorbidities were collected. Kaplan Meier curves were used to determine if OS differed between those with or without history of nephrectomy and a log rank test was used to calculate significance.
Results: Out of 84 patients with stage 4 renal cancer who had received IO during treatment, 43 had a history of nephrectomy and 41 did not. Age, race, and gender were not significantly different between groups. Endocrine comorbidities (diabetes and hypothyroidism) were more frequent in patients who had a nephrectomy (41.9% vs. 19.5%, p=0.03), but otherwise comorbidity status was not significantly different. Median follow up time was 34.1 months for those with a nephrectomy and 30.8 months for those without a nephrectomy. Kaplan Meier 5-year OS estimates were 61.7% and 35.1% (p=0.016) for those with and without nephrectomy, respectively (Figure 1).
Conclusions: Nephrectomy in the era of IO improves OS in patients with stage 4 renal cancer. Future studies with larger sample sizes and tumor characteristics must be performed to confirm these findings. Enrolling to on-going cytoreductive nephrectomy clinical trials is critical to determine the optimal role and timing of surgery and systemic immunotherapy.
