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Prognostic model of upfront cytoreductive nephrectomy in patients with metastatic renal cell carcinoma treated with immune checkpoint inhibitors and/or targeted agents

  • Urology - Original Paper
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Abstract

Introduction and objectives

The aim of this study was to investigate prognostic factors and to establish a prognostic model using them for upfront cytoreductive nephrectomy (CN) in patients with metastatic renal cell carcinoma (mRCC) treated with immune checkpoint inhibitor (ICI) and/or tyrosine kinase inhibitor (TKI).

Materials and methods

Two hundred eleven patients who were diagnosed as mRCC at initial diagnosis and were treated with TKI and/or ICI were classified into 2 groups: those undergoing CN (upfront CN group, 117 cases) and those who initially underwent systemic therapy (non-upfront CN group, 94 cases). In the upfront CN group, the patients’ background and overall survival (OS) were compared with those in the other two groups, and prognostic factors were analyzed. A prognostic model of the upfront CN group was established.

Results

The median of the observation period for the upfront CN group was 25 months. The rates of patients with clear cell histology, with a Karnofsky performance status (KPS) of ≥ 80%, with a single metastatic organ, with a normal pretreated C-reactive protein level, and with an intermediate risk according to the International mRCC Database Consortium (IMDC) model were significantly higher than those in the non-upfront CN group (87.2% and 30.9%, p < 0.0001; 92.3% and 77.7%, p = 0.0025; 41.9% and 24.5%, p = 0.0080; 47.9% and 13.8%, p < 0.0001; 66.7% and 45.7%, p = 0.0023, respectively). The 50% OS in the upfront CN group was 33.1 months, significantly better than that in the non-upfront CN group (11.1 months, p < 0.0001), and these results were consistent regardless of their prognostic risk level. Multivariate analysis showed that multiple metastatic organs and a KPS of < 80% were independent predictive factors for OS (hazard ratio: 1.653 and 2.995, p = 0.0339 and 0.0054, respectively). Using these two parameters to stratify the upfront CN group, the 50% OSs in cases with no risk factors, in those with one factor, and in those with two factors were 43.4 months, 29.1 months, and 7.7 months, respectively (p < 0.0001).

Conclusion

The upfront CN group was able to be stratified by our prognostic model into three subgroups with different prognoses. This model can provide useful information for making decisions in consideration of upfront CN in patients with mRCC.

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Acknowledgements

In addition to the authors, the following investigators participated in the study: Kenichiro Fukuoka, Kure Medical Center; Hiroshi Masumoto and Keiji Nagasaka, Fukuyama Medical Center; Shinya Ohara and Kosuke Sadahide, Hiroshima Prefectural Hospital; Shogo Inoue and Koichi Shoji, Mazda Hospital; Hideo Iwamoto and Yoshito Kagiyama, Higashi-Hiroshima Medical Center; Ryo Tasaka, Hiroshima General Hospital; Hideki Mochizuki, Hiroyuki Shikuma, and Tomoya Hatayama, Hiroshima City Asa Citizens Hospital; Yoshinori Shigematsu, Chugoku Rosai Hospital; Shunsuke Shinmei and Ryoken Yamanaka, Hiroshima-Nishi Medical Center; and Hideo Iwamoto and Naofumi Nomura, Onomichi General Hospital.

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Authors and Affiliations

  1. Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan

    Jun Teishima, Keisuke Goto, Yohei Sekino, Tetsutaro Hayashi & Nobuyuki Hinata

  2. Department of Urology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan

    Koji Mita

  3. Department of Urology, Fukuyama Medical Center, Fukuyama, Japan

    Yasuhisa Hasegawa

  4. Department of Urology, Hiroshima General Hospital, Hatsukaichi, Japan

    Masao Kato

  5. Department of Urology, Hiroshima Prefectural Hospital, Hiroshima, Japan

    Mitsuru Kajiwara

  6. Department of Urology, Kure Medical Center and Chugoku Cancer Center, Kure, Japan

    Masanobu Shigeta

  7. Department of Urology, Miyoshi Central Hospital, Miyoshi, Japan

    Satoshi Maruyama

  8. Department of Urology, Onomichi General Hospital, Onomichi, Japan

    Yuichi Kadonishi

  9. Department of Urology, Higashi-Hiroshima Medical Center, Higashi-Hiroshima, Japan

    Seiji Fujiwara

  10. Department of Urology, Chugoku Rosai Hospital, Kure, Japan

    Kanao Kobayashi

  11. Department of Urology, Hiroshima-Nishi Medical Center, Ohtake, Japan

    Kousuke Asano

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  1. Jun Teishima
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Correspondence to Jun Teishima.

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Conflict of interest

Jun Teishima received lecture fees from Merck Inc. and Pfizer Inc.

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For this type of study formal consent is not required. Pursuant to the provisions of the ethics committee and the ethic guideline in Japan, written consent was not required in exchange for public disclosure of study information in the case of retrospective and/or observational study using a material such as the existing documentation.

Research involving human participants and/or animals

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Teishima, J., Goto, K., Sekino, Y. et al. Prognostic model of upfront cytoreductive nephrectomy in patients with metastatic renal cell carcinoma treated with immune checkpoint inhibitors and/or targeted agents. Int Urol Nephrol 54, 1225–1232 (2022). https://doi.org/10.1007/s11255-022-03157-w

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  • DOI: https://doi.org/10.1007/s11255-022-03157-w

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