Survival Analyses of Patients With Metastatic Renal Cancer Treated With Targeted Therapy With or Without Cytoreductive Nephrectomy: A National Cancer Data Base Study

Abstract

Purpose: The role of cytoreductive nephrectomy (CN) in metastatic renal cell carcinoma (mRCC) has become unclear since the introduction of targeted therapies (TT). We sought to evaluate contemporary utilization rates of CN and to examine the survival benefit of CN compared with non-CN patients treated with TT.

Methods: We used the National Cancer Data Base to identify patients with clinical mRCC treated with TT between 2006 and 2013. The intervention of interest was CN. Multivariable logistic regression predicting receipt of CN was performed. Overall survival (OS) was examined using Cox regression models and incremental survival analyses were performed. Sensitivity analyses using propensity scores were conducted.

Results: Of 15,390 patients treated with TT, 5,374 (35%) underwent CN between 2006 and 2013. Patients who were younger, privately insured, treated at an academic center, and had lower tumor stage and cN0 disease were more likely to undergo CN. The median OS of CN versus non-CN patients was 17.1 (95% CI, 16.3 to 18.0 months) versus 7.7 months (95% CI, 7.4 to 7.9 months; P < .001). In sensitivity analyses using propensity scores adjustment in addition to other available covariates, CN patients had a lower risk of any death (hazard ratio, 0.45; 95% CI, 0.40 to 0.50; P < .001). The survival benefit of CN was +0.7 and +3.6 months in patients who survived ≤ 6 and ≤ 24 months, respectively, versus no CN.

Conclusion: CN is performed in three of 10 patients with mRCC who are receiving TT. Several patient and sociodemographic characteristics were associated with receipt of CN. When feasible, CN may offer an OS benefit when combined with TT.

Fig 1.

CONSORT diagram of patient selection within the National Cancer Data Base (NCDB), 2006 to 2013. CN, cytoreductive nephrectomy; ICD, International Classification of Diseases; mRCC, metastatic renal cell carcinoma; PUF, participant user file.

Fig 2.

Kaplan-Meier survival analyses of patients with metastatic renal cell carcinoma treated with targeted therapy stratified according to cytoreductive nephrectomy (CN) status (yes or no), National Cancer Data Base, 2006 to 2012. Data were restricted to 12,995 patients with no missing information on vital status or follow-up time.

Fig 3.

Kaplan-Meier survival analyses of patients with metastatic renal cell carcinoma treated with cytoreductive nephrectomy and targeted therapy (TT) stratified according to timing of surgery (before or after systemic therapy), National Cancer Data Base, 2006 to 2012. Data were restricted to 4,223 patients with available information on timing of surgery and targeted therapy.