30: Patient-reported outcomes improve following cytoreductive nephrectomy

Background: Few studies have used patient-reported outcomes (PROs) to evaluate patients’ quality of life as a benefit from cytoreductive nephrectomy (CN). We aimed to evaluate PROs in mRCC patients before and after CN using the NCCN FKSI-19 instrument, a validated 19-item questionnaire used to measure PROs in patients with kidney cancer.

Methods: Patients undergoing upfront CN at two institutions over two years completed FKSI-19 within 30 days preoperatively and 4-6 weeks postoperatively. The FKSI-19 score ranges from 0-76 with higher scores indicating fewer symptoms. The FKSI-19 subdomains include disease-related symptoms (DRS), DRS-emotional (DRS-E), DRS-physical (DRS-P), and functional well-being (FWB). Wilcoxon matched-pairs signed rank test and Fisher’s exact test were used to compare pre- and postoperative scores. Clinically meaningful improvements in FKSI-19 score were considered if the score increased ≥5 points postoperatively. Logistic regression was used to determine variables associated with meaningful improvements in FKSI scores.

Results: Twenty-five patients completed a pre and postop FKSI. Median preop FKSI was 57 (IQR 47-63) and postop 59 (IQR 51-64) (p=0.2) with a median change of +3 points. Tumor size, gender, surgical approach (open vs. laparoscopic), age, and race were not associated with a change in FKSI postoperatively (p>0.05 for all). Among the domains, the DRS-E score, which ranges from 0-4, significantly improved postop (median +2 vs +3, p< 0.001), indicating patients were less worried their cancer would worsen after CN. 11/25 (44%) patients had meaningful improvements in postop FKSI. Preop FKSI score was inversely associated with meaningful improvements in postop FKSI (OR 0.89 95%CI 0.8-0.96, p=0.02).

Conclusions: Patient-reported outcomes showed improvement following CN, with the most improvement demonstrated in patients who were more symptomatic prior to CN. Continued prospective evaluation of CN PROs will help define which patients are most likely to benefit from CN.