Development of a Novel Risk Score to Select the Optimal Candidate for Cytoreductive Nephrectomy Among Patients with Metastatic Renal Cell Carcinoma. Results from a Multi-institutional Registry (REMARCC)

Marchioni, Michele; Kriegmair, Maximilian C.; Heck, M.; Amiel, Thomas; Porpiglia, Francesco; Ceccucci, Enrico; Campi, Riccardo; Minervini, Andrea; Mari, Andrea; Bruwaene, Siska Van; Linares, Estefanía; Hevia, Vital; Musquera, Mireía; D’Anna, M.; Derweesh, Ithaar; Bradshaw, Aaron; Autorino, Riccardo; Guruli, Georgi; Veccia, Alessandro; Roussel, Eduard; Albersen, Maarten; Pavan, Nicola; Claps, Francesco; Antonelli, Alessandro; Palumbo, Carlotta; Klatte, Tobias; Erdem, Selçuk; Mir, Maria Carmen

doi:10.1016/j.euo.2020.12.010

Cited by 28 publications

(23 citation statements)

References 28 publications

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“…They identified six poor prognostic factors: ≤30 body mass index, lung metastasis, liver metastasis, bone metastasis, >3 metastatic lesions, and <80 KPS. 46 We conducted external validation of the REMARCC classification and showed that IPTW-adjusted OS with CN was longer with CN than without CN with a low score (0-2 factors; HR 0.36; 95% CI 0.25-0.53), whereas it was similar with intermediate and high scores (3-6 factors; HR 0.91; 95% CI 0.54-1.54). 47 Briefly, previous retrospective studies in the TT era inferred that immediate CN may be considered for patients who can expect long-term survival (Fig.…”

Section: Immediate Cn (Table 1)mentioning

confidence: 98%

“…The European Association of Urology Young Academic Urologist Kidney Cancer group developed the REMARCC classification using 519 synchronous mRCC patients undergoing CN. They identified six poor prognostic factors: ≤30 body mass index, lung metastasis, liver metastasis, bone metastasis, >3 metastatic lesions, and <80 KPS 46 . We conducted external validation of the REMARCC classification and showed that IPTW‐adjusted OS with CN was longer with CN than without CN with a low score (0–2 factors; HR 0.36; 95% CI 0.25–0.53), whereas it was similar with intermediate and high scores (3–6 factors; HR 0.91; 95% CI 0.54–1.54) 47 .…”

Section: Immediate Cn (Table 1)mentioning

confidence: 99%

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Surgical and focal treatment for metastatic renal cell carcinoma: A literature review

2022

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Abbreviations & Acronyms AS = active surveillance cCa = corrected calcium CI = confidence interval CN = cytoreductive nephrectomy CNS = central nervous system CR = complete response HR = hazard ratio ICI = immune checkpoint inhibitor IFN-a = interferon alpha IMDC = International Metastatic RCC Database Consortium IPTW = propensity scorebased inverse probability of treatment weight KPS = Karnofsky performance status mRCC = metastatic renal cell carcinoma NLR = neutrophil-tolymphocyte ratio ORR = objective response rate OS = overall survival PFS = progression-free survival RCC = renal cell carcinoma RCT = randomized controlled trial REMARCC = registry for metastatic renal cell carcinoma SBRT = stereotactic radiation therapy SRS = stereotactic radiosurgery TT = targeted therapy WBRT = whole-brain radiotherapy

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Section: Immediate Cn (Table 1)mentioning

confidence: 98%

Section: Immediate Cn (Table 1)mentioning

confidence: 99%

Surgical and focal treatment for metastatic renal cell carcinoma: A literature review

2022

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“…A result from the multi-institutional registry (REMARCC) showed that different metastatic sites had different effects on the survival benefits of patients with mRCC. The survival rate of patients with distant metastasis were often worse ( 33 ). Similar to their study, we found that patients with distant metastasis were often apt to early death, especially those with liver and brain metastasis.…”

Section: Discussionmentioning

confidence: 99%

A Simple-To-Use Nomogram for Predicting Early Death in Metastatic Renal Cell Carcinoma: A Population-Based Study

Chen

Zhan

Du³

et al. 2022

Front. Surg.

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BackgroundMetastatic renal cell carcinoma (mRCC) is usually considered to have a poor prognosis, which has a high risk of early death (≤3 months). Our aim was to developed a predictive nomogram for early death of mRCC.MethodsThe SEER database was accessed to obtain the related information of 6,005 mRCC patients between 2010 and 2015. They were randomly divided into primary cohort and validation cohort in radio of 7:3. The optimal cut-off point regarding age at diagnosis and tumor size were identified by the X-tile analysis. Univariate and multivariate logistic regression models were applied to determine significant independent risk factors contributed to early death. A practical nomogram was constructed and then verified by using calibration plots, receiver operating characteristics (ROCs) curve, and decision curve analysis (DCA).ResultsThere were 6,005 patients with mRCC included in the predictive model, where 1,816 patients went through early death (death within ≤3 months of diagnosis), and among them 1,687 patients died of mRCC. Based on 11 significant risk factors, including age, grade, N-stage, histologic type, metastatic sites (bone, lung, liver and brain) and treatments (surgery, radiation, and chemotherapy), a practical nomogram was developed. The model's excellent effectiveness, discrimination and clinical practicality were proved by the AUC value, calibration plots and DCA, respectively.ConclusionsThe nomogram may play a major part in distinguishing the early death of mRCC patients, which can assist clinicians in individualized medicine.

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“…Even though numerous prognostic scales have been developed for this purpose during the cytokine era, external validation has shown that they all perform poorly in a targeted therapy-predominant cohort [62]. For this reason, newer scales have been developed during the targeted therapy era; examples include those by McIntosh et al [67] and Marchioni et al [68]. However, these remain to be prospectively evaluated and externally validated before they can be implemented into routine clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Survival Outcomes of Cytoreductive Nephrectomy Combined with Targeted Therapy for Metastatic Renal Cell Carcinoma: A Systematic Review and Individual Patient Data Meta-Analysis

Esagian¹,

Ziogas²,

Kosmidis

et al. 2021

Cancers

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The role of cytoreductive nephrectomy (CN) in the treatment of metastatic renal cell carcinoma (mRCC) remains controversial during the targeted therapy era. To reconcile the current literature, we analyzed the reported survival data at the individual patient level and compared the long-term survival outcomes of CN combined with targeted therapy vs. targeted therapy alone in patients with mRCC. We performed a systematic review of the literature using the MEDLINE, Scopus, and Cochrane Library databases (end-of-search date: 21 July 2020). We recuperated individual patient data from the Kaplan–Meier curves for overall (OS), progression-free (PFS), and cancer-specific survival (CSS) from each study. We subsequently performed one-stage frequentist and Bayesian random-effects meta-analyses using both Cox proportional hazards and restricted mean survival time (RMST) models. Two-stage random-effects meta-analyses were also performed as sensitivity analyses. A subgroup analysis was also performed to determine the effect of CN timing. Fifteen studies fulfilling our inclusion criteria were identified, including fourteen retrospective cohort studies and one randomized controlled trial. In the one-stage frequentist meta-analysis, the CN group had superior OS (hazard ratio [HR]: 0.58, 95% confidence interval [CI]: 0.54–0.62, p < 0.0001) and CSS (HR: 0.63, 95% CI: 0.53–0.75, p < 0.0001). No meaningful clinical difference was observed in PFS (HR: 0.90, 95% CI: 0.80–1.02, p = 0.09). One-stage Bayesian meta-analysis also revealed superior OS (HR: 0.59, 95% credibility interval [CrI]: 0.55–0.63) and CSS (HR: 0.63, 95% CrI: 0.53–0.75) in the CN group, while no meaningful clinical difference was detected in PFS (HR: 0.91, 95% CrI: 0.80–1.02). Similar results were obtained with the RMST models. The OS benefit was also noted in the two-stage meta-analyses models, and in the subgroup of patients who received upfront CN. The combination of CN and targeted therapy for mRCC may lead to superior long-term survival outcomes compared to targeted therapy alone. Careful patient selection based on prognostic factors is required to optimize outcomes.

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Development of a Novel Risk Score to Select the Optimal Candidate for Cytoreductive Nephrectomy Among Patients with Metastatic Renal Cell Carcinoma. Results from a Multi-institutional Registry (REMARCC)

Cited by 28 publications

References 28 publications

Surgical and focal treatment for metastatic renal cell carcinoma: A literature review

Surgical and focal treatment for metastatic renal cell carcinoma: A literature review

A Simple-To-Use Nomogram for Predicting Early Death in Metastatic Renal Cell Carcinoma: A Population-Based Study

Long-Term Survival Outcomes of Cytoreductive Nephrectomy Combined with Targeted Therapy for Metastatic Renal Cell Carcinoma: A Systematic Review and Individual Patient Data Meta-Analysis

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