Timing of Cytoreductive Nephrectomy Does Not Affect Overall Survival Outcomes in Patients Receiving Immunotherapy for Metastatic Renal Cell Carcinoma

Document Type

Conference Proceeding

Publication Date

5-2025

Publication Title

Journal of Urology

Abstract

INTRODUCTION AND OBJECTIVE: The SURTIME trial showed that initial systemic therapy with sunitunib followed by cytoreductive nephrectomy (CN) was associated with improved overall survival (OS) compared with CN followed by sunitunib in patients with metastatic renal cell carcinoma (mRCC). These data are limited by a shift from the use of single agent tyrosine kinase inhibitors to immu-notherapy (IO)-based regimens. Herein, we assessed OS outcomes of mRCC patients treated with IO with or without CN utilizing the National Cancer Database (NCDB). METHODS: We identified mRCC patients treated with IO +/- CN in the NCDB. Patients were placed in one of three groups based onthe type and sequence of treatment received: IO alone, IO followed by CN (IO/CN), or CN followed by IO (CN/IO). We used a multivariable Cox proportional hazards model with clustered robust standard errors and Kaplan-Meier curves to compare differences in OS. Secondary objectives were to assess readmission rates, positive surgical margins, and length of stay among patients undergoing IO/CN and CN/IO. RESULTS: Of the patients identified, 785 received IO alone, 44 IO/CN, and 1,152 CN/IO. Among the three groups, there were significant differences in OS in the multivariable model (Wald statistic, p< 0.001). In pairwise comparisons, both CN/IO and IO/CN had improved OS compared with IO alone (HR 0.35, 95% CI: 0.28-0.44, p< 0.001 and HR 0.23, 95% CI: 0.13-0.39, p< 0.001, respectively), but there was no significant difference in OS between IO/CN and CN/IO (HR 0.64, 95% CI: 0.37-1.09, p=0.101). An adjusted OS survival curve is shown in Figure 1. Sequence of treatment was not significantly associated with positive surgical margins (IO/CN vs. CN/IO; adjusted OR: 1.08, 95% CI: 0.35-3.38, p=0.889), readmission rates (IO/CN vs.CN/IO; adjusted OR: 1.33, 95% CI: 0.15-11.4, p=0.795), or post-operative length of stay (IO/CN vs. CN/IO; adjusted IRR: 1.13, 95% CI:0.81-1.58, p=0.481). CONCLUSIONS: Patients with mRCC undergoing CN before or after IO had improved OS compared with IO alone. While there was no significant difference in OS between the CN/IO and IO/CN groups, point estimates favored those receiving IO/CN. These results are limited by the retrospective, non-randomized nature of the study as well as selection bias regarding which patients received specific treatments.

Volume

213

Issue

5S

First Page

e490

Last Page

e490

Comments

American Urological Association Annual Meeting, April 26-29, 2025, Las Vegas, NV

DOI

10.1097/01.JU.0001109872.73672.99.12

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