Presentation Authors: Timothy Lyon*, R. Houston Thompson, Christine Lohse, Paras Shah, Stephen Boorjian, Brian Costello, John Cheville, Bradley Leibovich, Rochester, MN
Introduction: Complete surgical resection of metastases from renal cell carcinoma (RCC) is associated with prolonged disease-free survival and occasional long-term cure in selected patients. However, the majority of existing data is from the immunotherapy era. Whether complete metastasectomy (CM) remains beneficial among contemporary patients, with more effective systemic therapies available, has not been well studied. Therefore, we examined outcomes of patients treated with CM in the era of targeted therapy and checkpoint blockade availability.
Methods: We queried our institutional nephrectomy registry to identify patients treated with radical or partial nephrectomy for unilateral, sporadic RCC whose first occurrence of distant metastases occurred between 2006-2017. Patients were classified according to whether or not they underwent complete surgical resection of all sites of metastatic disease. Cancer-specific survival (CSS) was estimated using the Kaplan-Meier method, and associations of clinicopathologic features with time to death from RCC were assessed using Cox proportional hazards models.
Results: A total of 586 patients were identified, including 158 treated with CM. Median follow up after diagnosis of metastases was 3.9 years, during which time 403 patients died, including 345 from RCC. CM patients were more likely to have metastases diagnosed > 1 year after nephrectomy and to have a solitary site of metastasis than those without CM (p < 0.001 for both). Of the CM patients, 147 (93%) did not require systemic therapy (targeted therapy or immunotherapy) for their index metastatic lesion(s). Two-year CSS was significantly greater for patients with CM than for those without (84% vs. 54%, p < 0.001). After adjusting for age, sex, and the timing, number, and location of metastases, CM was associated with a significantly reduced likelihood of death from RCC (HR 0.42, 95% CI 0.31-0.57, p < 0.001).
Conclusions: Complete surgical resection of metastases from RCC is associated with improved CSS in the contemporary era. CM should continue to be considered a viable treatment option for select patients with metastatic RCC.