Multidisciplinary team referral at diagnosis for patients with non-metastatic renal cell carcinoma

• Published in: Urologic oncology 2022-08, Vol.40 (8), p.384-384.e14
• Main Authors: Martini, Alberto, Fallara, Giuseppe, Pellegrino, Antony A., Nocera, Luigi, Larcher, Alessandro, Raggi, Daniele, Campi, Riccardo, Ploussard, Guillaume, Malavaud, Bernard, Montorsi, Francesco, Pal, Sumanta K., Spiess, Philippe E., Choueiri, Toni K., Necchi, Andrea, Capitanio, Umberto
• Format: Article
• Language: English
• Subjects: Clinical trials; Deferred therapy; Multidisciplinary team; Neoadjuvant therapy; Renal cell carcinoma
• ISSN: 1078-1439; 1873-2496
• DOI: 10.1016/j.urolonc.2022.05.004

•To date, multidisciplinary team (MDT) evaluation, enrollment in trials evaluating the role of perioperative therapies and deferred active treatments represent accepted strategies for patients with Renal Cell Carcinoma (RCC).•We aimed to identify subgroups of patients with RCC who may benefit from early referral for MDT evaluation at diagnosis in light of an increased risk of recurrence relative to the risk of dying of other causes.•The risk of other cause mortality (OCM) was evaluated against the risk of distant metastasis over time by means of the Weibull regression.•For each combination of cT stage, age, and Charlson comorbidity index, the potential need for an MDT referral was defined when the risk of recurrence exceeded the risk of OCM within the lower limit of the 95% CI of the meantime to recurrence.•Our approach can help in selecting the optimal candidates for multidisciplinary evaluations at RCC diagnosis. To date, multidisciplinary team (MDT) evaluation, enrollment in trials evaluating the role of perioperative therapies and deferred active treatments represent accepted strategies for patients with Renal Cell Carcinoma (RCC), which are under investigation to maximize cancer control and implement health care policies and value-based care. Here, we aimed to identify subgroups of patients with RCC who may benefit from early referral for MDT evaluation at diagnosis in light of an increased risk of recurrence relative to the risk of dying of other causes. We relied on a prospective dataset including patients diagnosed with RCC from 1998 to 2019 and treated by means of surgery alone at a tertiary referral center. The risk of other cause mortality (OCM) was evaluated against the risk of distant metastasis over time by means of the Weibull regression. Patients were stratified based on clinical stage (cT1a; cT1b; cT2; cT3-4), age (70) and comorbidities [Charlson comorbidity index (CCI) 0 vs. ≥1]. For each combination of cT stage, age, and CCI, the potential need for an MDT referral was defined when the risk of recurrence exceeded the risk of OCM within the lower limit of the 95% CI of the meantime to recurrence. Overall, 1,162 (51%) patients had no comorbidities. Median follow-up was 7 years. Patients who would benefit most from an MDT evaluation are those diagnosed with A) cT3-4 disease (any age or comorbidity) or B) cT2 cancers if healthy and younger than 70 years or younger than 60 years with at least 1 comorbidity or C) cT1b if younger th