Prognostic effect of cytoreductive nephrectomy in synchronous metastatic renal cell carcinoma: a comparative study using inverse probability of treatment weighting

• Published in: World journal of urology 2018-03, Vol.36 (3), p.417-425
• Main Authors: Klatte, Tobias, Fife, Kate, Welsh, Sarah J., Sachdeva, Manavi, Armitage, James N., ‘Aho, Tevita, Riddick, Antony C., Matakidou, Athena, Eisen, Tim, Stewart, Grant D.
• Format: Article
• Language: English
• Subjects: Clinical trials; Kidney cancer; Kidney transplantation; Medicine; Medicine & Public Health; Metastases; Metastasis; Nephrectomy; Nephrology; Oncology; Original Article; Regression analysis; Renal cell carcinoma; Sensitivity analysis; Statistical analysis; Targeted cancer therapy; Thrombocytosis; Urology
• ISSN: 0724-4983; 1433-8726
• DOI: 10.1007/s00345-017-2154-x

Purpose To test the hypothesis that cytoreductive nephrectomy (CN) improves overall survival (OS) of patients with synchronous metastatic renal cell carcinoma (mRCC), who subsequently receive targeted therapies (TT). Methods We identified 261 patients who received TT for synchronous mRCC with or without prior CN. To achieve balance in baseline characteristics between groups, we used the inverse probability of treatment weighting (IPTW) method. We conducted OS analyses, including IPTW-adjusted Kaplan–Meier curves, Cox regression models, interaction term, and landmark and sensitivity analyses. Results Of the 261 patients, 97 (37.2%) received CN and 164 (62.8%) did not. IPTW-adjusted analyses showed a statistically significant OS benefit for patients treated with CN (HR 0.63, 95% CI 0.46–0.83, P  = 0.0015). While there was no statistically significant difference in OS at 3 months ( P  = 0.97), 6 months ( P  = 0.67), and 12 months ( P  = 0.11) from diagnosis, a benefit for the CN group was noted at 18 months ( P  = 0.005) and 24 months ( P  = 0.004). On interaction term analyses, the beneficial effect of CN increased with better performance status ( P  = 0.06), in women ( P  = 0.03), and in patients with thrombocytosis ( P  = 0.01). Conclusions IPTW-adjusted analysis of our patient cohort suggests that CN improves OS of patients with synchronous mRCC treated with TT. On the whole, the survival difference appears after 12 months. Specific subgroups may particularly benefit from CN, and these subgroups warrant further investigation in prospective trials.