Summary
The clinical benefits of cytoreductive nephrectomy (CN) for metastatic renal cell carcinoma (mRCC) remains uncertain. Since the CARMENA trial showing minimal benefit, the contemporary use of CN and its survival benefits remains unknown. Herein, we aimed to identify the current trends of CN and factors associated with its use along with overall survival (OS) from a population-based cohort.
Methods
From 2013 to 2023, we identified all patients with mRCC (staged Tany Nany M1) within the Cancer Lin-Q, which is a national database of medical oncology practices in the U.S. The primary outcomes were use of CN and overall survival at 5 years. Multivariable logistic regression analyses were used to identify factors associated with CN including age, race, ECOG performance status, gender, and year. Cox proportional hazard ratios were used determine covariates associated with OS including age, race, gender, ECOG performance status, T stage, N stage, tumor histology, and year.
Results
Amongst the 584 patients with mRCC, 66 patients underwent CN in the U.S. During the study interval, the use of CN dramatically decreased from 2019 – 2020 (OR: 0.045; p=0.004), 2021 – 2023 (OR: 0.08; p=0.0002) compared to 2013 – 2014 on multivariable analysis (Table 1). However, patients undergoing CN was associated with better overall survival on multivariable analysis (HR: 1.45; p=0.04) and Kaplan Meier analysis (Figure 1).
Conclusions
The use of CN has substantially decreased in the United States. However, we demonstrated a decrease in OS for those not undergoing CN over a 5-year interval. Further study is needed to elucidate the role of CN moving forward as the treatment landscape continues to evolve for mRCC.
