Monday July 01, 2019 from 07:30 to 09:00
Outcomes of cytoreductive nephrectomy (CN) in metastatic renal cell carcinoma (mRCC) patients using real-world data from Canadian hospital centres
Alice Dragomir1, Sara Nazha1, Simon Tanguay1, Anil Kapoor2, Sebastien Hotte2, Ricardo A. Rendon3, Antonio Finelli4, Aaron Hansen4, Naveen Basappa5, Adrian Fairey5, Christian Kollmannsberger6, Alan I. So6, Jean-Baptiste Lattouf7, Georg Bjarnason8, Daniel Heng10, Neil M. Reaume9, Rodney H. Breau9, Frédéric Pouliot11, Bimal Bhindi12, Lori A. Wood3.
1Urology, McGill University Health Centre, Montréal, QC, Canada; 2Urology, Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada; 3Urology, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada; 4Urology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada; 5Urology, Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada; 6Urology, BC Cancer Agency Vancouver Cancer Centre, Vancouver, BC, Canada; 7Urology, Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada; 8Urology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada; 9Urology, The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada; 10Medical Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada; 11Urology, Centre Hospitalier Universitaire de Québec, Université Laval, Quebec City, QC, Canada; 12Medical Oncology, Southern Alberta Institute of Urology, Alberta, AB, Canada
Introduction: The objective of this study was to use real-world data (RWD) to evaluate and compare the outcomes of metastatic renal cell carcinoma (mRCC) patients who underwent cytoreductive nephrectomy (CN) with or without targeted treatment (TT) compared to patients who only received TT.
Methods: The Canadian Kidney Cancer information system (CKCis) database was used to identify patients diagnosed with mRCC after January 2011. Patients were stratified into four different groups: CN without TT, CN followed by TT, TT followed by CN, TT alone. Kaplan-Meier curve was used to estimate the overall survival (OS) from diagnosis of mRCC to death from any cause for the following groups: 1) CN without TT; 2) CN before or after TT; and 3) and TT alone. A Cox proportional hazards model was used to assess the impact of the CN while adjusting for potential confounding variables.
Results: A total of 813 patients were included in the analysis; 663 (81.6%) patients underwent CN and 150 (18.5%) did not. Of the 663 patients in the CN group, 202 did not receive any TT and 461 received TT (383 preceded by CN and 78 followed by CN). The median time between CN to TT initiation and between TT initiation to CN was three (interquartile range [IQR] 2–8] and five (IQR 3–9) months, respectively, with a median TT duration of five (IQR 2–11) and seven (IQR 3–14) months, respectively. The median OS for patients undergoing CN without TT, CN with TT, and TT alone was not reached, 37 months (95% confidence interval [CI] 29–43), and 13 months (95% CI 10–19), respectively. Having a metastasectomy (hazard ratio [HR] 0.51; 95% CI 0.37–0.73) and clear-cell histology (HR 0.69; 95% CI 0.54–0.87) were associated with improved survival. Compared to patients in the CN before or after TT group, CN without TT patients presented an improved survival (HR 0.57; 95% CI 0.41–0.80), but patients in the TT group alone presented a decreased survival (HR 2.14; 95% CI 1.68–2.74).
Conclusions: Our study presents the clinical impact of CN in mRCC patients using RWD. Further analyses will be conducted in subgroups of patients and using matched analysis to decrease confounding by indication in this population.