Improved Survival in Contemporary Community-Based Patients With Metastatic Clear-Cell Renal Cell Carcinoma Undergoing Active Treatment
Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
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Department of Urology, Medical University of Graz, Graz, Austria
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Department of Urology, IRCCS Ospedale Galeazzi - Sant’Ambrogio, Milan, Italy
Department of Urology, IRCCS Policlinico San Donato, Milan, Italy
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Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
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Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Laboratory, IRCCS San Raffaele Scientific Institute, Milan, Italy
Vita-Salute San Raffaele University, Milan, Italy
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Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
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Department of Urology, Weill Cornell Medical College, New York, New York
Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
Hourani Center of Applied Scientaific Research, Al-Ahliyya Amman University, Amman, Jordan
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Vita-Salute San Raffaele University, Milan, Italy
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Department of Urology, IRCCS Policlinico San Donato, Milan, Italy
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Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
Department of Urology, Koc University Hospital, Istanbul, Turkey
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Background: We hypothesized that the evolving treatment paradigms recommended based on phase III trials may have translated into improved overall survival (OS) in contemporary community-based patients with clear-cell metastatic renal cell carcinoma (ccmRCC) undergoing active treatment. Patients and Methods: Within the SEER database, contemporary (2017–2020) and historical (2010–2016) patients with ccmRCC treated with either systemic therapy (ST), cytoreductive nephrectomy (CN), or both (ST+CN) were identified. Univariable and multivariable Cox-regression models were used. Results: Overall, 993 (32%) contemporary versus 2,106 (68%) historical patients with ccmRCC were identified. Median OS was 41 months in contemporary versus 25 months in historical patients (Δ=16 months; P<.001). In multivariable Cox-regression analyses, contemporary membership was independently associated with lower overall mortality (hazard ratio [HR], 0.7; 95% CI, 0.6–0.8; P<.001). In patients treated with ST alone, median OS was 17 months in contemporary versus 10 months in historical patients (Δ=7 months; P<.001; multivariable HR, 0.7; P=.005). In patients treated with CN alone, median OS was not reached in contemporary versus 33 months in historical patients (Δ=not available; P<.001; multivariable HR, 0.7; P<.001). In patients treated with ST+CN, median OS was 38 months in contemporary versus 26 months in historical patients (Δ=12 months; P<.001; multivariable HR, 0.7; P=.003). Conclusions: Contemporary community-based patients with ccmRCC receiving active treatment clearly exhibited better survival than their historical counterparts, when examined as one group, as well as when examined as separate subgroups according to treatment type. Treatment advancements of phase III trials seem to be applied appropriately outside of centers of excellence.
Submitted June 24, 2023; final revision received December 19, 2023; accepted for publication January 16, 2024. Published online June 5, 2024.
Author contributions: Conceptualization: Incesu, Karakiewicz. Formal analysis: Incesu, Tian. Methodology: Incesu, Tian. Project administration: Karakiewicz. Resources: Tian. Software: Tian. Supervision: Saad, Shariat, Chun, Briganti, de Cobelli, Carmignani, Ahyai, Longo, Tilki, Graefen, Karakiewicz. Visualization: Incesu, Morra, Scheipner, Baudo, Ippolita Jannello, de Angelis, Siech, Assad. Writing—original draft: Incesu. Writing—review & editing: Incesu, Morra, Scheipner, Baudo, Ippolita Jannello, de Angelis, Siech, Assad, Saad, Shariat, Chun, Briganti, de Cobelli, Carmignani, Ahyai, Longo, Tilki, Graefen, Karakiewicz. Final approval of manuscript: All authors.
Disclosures: The authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.
© 2019-2024 National Comprehensive Cancer Network