Metastatic Tumor Burden Does Not Predict Overall Survival Following Cytoreductive Nephrectomy for Renal Cell Carcinoma: a Novel 3-Dimensional Volumetric Analysis

Blute, Michael L.; Ziemlewicz, Timothy J.; Lang, Joshua M.; Kyriakopoulos, Christos E.; Jarrard, David F.; Downs, Tracy M.; Grimes, Matthew D; Shi, Fangfang; Mann, Michael; Abel, E. Jason

doi:10.1016/j.urology.2016.09.016

Cited by 5 publications

(3 citation statements)

References 20 publications

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“…Blute et al similarly illustrated that unidimensional measurements were unsuitable for calculating volume, this was not linked to differences between sphericity. 12 Nonetheless, our findings demonstrated a strong concordance between both increases in log10(PV) and unidimensional size measurements with overall survival.…”

Section: Cuaj -Original Researchsupporting

confidence: 57%

An evaluation of the role of tumor load in cytoreductive nephrectomy

Silagy

Düzgöl

Marcon

et al. 2020

CUAJ

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Introduction: New radiological tools can accurately provide preoperative three-dimensional spatial assessment of metastatic renal cell carcinoma (RCC) We aimed to determine whether the distribution, volume, shape, and fraction of RCC resected in a cytoreductive nephrectomy associates with survival. Methods: We retrospectively reviewed 560 patients undergoing cytoreductive nephrectomy performing a comprehensive volumetric analysis in eligible patients of all detectable primary and metastatic RCC prior to surgery. We used Cox regression analysis to determine the association between the volume, shape, fraction resected, and distribution of RCC and overall survival (OS). Results: There were 62 patients eligible for volumetric analysis, with similar baseline characteristics to the entire cohort, and median survivor followup was 34 months. Larger primary tumors were less spherical, but not associated with different metastatic patterns. Increased primary tumor volume and tumor size, but not the fraction of tumor resected, were associated with inferior survival. The rank of tumors based on unidimensional size did not completely correspond to the rank by primary tumor volume, however, both measurements yielded similar concordance for predicted OS. Larger tumor volume was not associated with a longer postoperative time off treatment. Conclusions: Primary tumor volume was significant for predicting OS, while the fraction of disease resected did not appear to impact upon patient outcomes. Although rich in detail, our study is potentially limited by selection bias. Future temporal studies may help elucidate whether the primary tumor shape is associated with tumor growth kinetics.

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Section: Cuaj -Original Researchsupporting

confidence: 57%

An evaluation of the role of tumor load in cytoreductive nephrectomy

Silagy

Düzgöl

Marcon

et al. 2020

CUAJ

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“…Mixed results have been reported regarding the association of metastatic extent and prognosis in the CN setting; patients whose primary tumors represent a higher percentage of the total volume of disease seem to benefit the most from surgical intervention. However, a few small retrospective studies have also shown that total disease volume does not influence survival [27][28][29]. We think that both features (primary tumor size and metastatic burden) are a reflection of the underlying tumor biology, which is (potentially) the real driver of disease aggressiveness in this setting.…”

Section: Discussionmentioning

confidence: 89%

The Association Between Small Primary Tumor Size and Prognosis in Metastatic Renal Cell Carcinoma: Insights from Two Independent Cohorts of Patients Who Underwent Cytoreductive Nephrectomy

DiNatale

Xie

Becerra

et al. 2020

European Urology Oncology

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Background: One of the main challenges in the management of renal cell carcinoma (RCC) is risk-stratifying patients who present with metastatic disease. Tumor size is an important predictor of survival in the localized setting; however, this feature has not been explored fully in patients presenting with M1 RCC.Objective: To assess the impact of tumor size on survival in patients with metastatic RCC who underwent cytoreductive nephrectomy (CN).Design, setting, and participants: We queried the Memorial Sloan Kettering (MSK) nephrectomy database for patients who presented with M1 disease and underwent CN between 1989 and 2016 (n = 304). Primary tumor size was obtained from pathology reports. Data from the International Metastatic Database Consortium (IMDC) were used for validation purposes (n = 778).Outcome measurements and statistical analysis: Overall survival (OS) estimates were computed using the Kaplan-Meier method. Cox regressions were used to test the association between tumor size and OS in univariate and multivariable analyses. Tumors ≤4 cm were compared with larger masses. Secondary analyses were performed to assess the robustness of these findings. Results and limitations:Clear cell tumors ≤4 cm were significantly associated with improved OS in both the MSK (hazard ratio [HR]: 0.35, 0.17-0.72, p = 0.004) and IMDC (HR 0.54, 0.36-0.83, p = 0.004) cohorts. The association was observed even after adjusting for known prognostic factors (HR 0.40, 0.14-1.14, p = 0.09 and HR: 0.54, 0.33-0.90, p = 0.02 in the MSK and IMDC cohorts, respectively). Limitations of this study include the absence of patients who were considered poor surgical candidates as well as potential selection bias. Conclusions:The primary tumor size ≤4 cm was independently associated with improved OS in patients with metastatic clear cell RCC who underwent CN. Additionally, the association between primary size and survival was found to be nonlinear. These findings suggest that there is a group of small metastatic RCCs that can convey a better overall prognosis. The potential role of primary tumor size when risk stratifying patients with M1 RCC should be explored further to determine its utility during clinical decision making.

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“…For example, although metastatic tumor burden in three- dimensional volumetric analysis does not predict survival of mRCC patients, a composite biomarker score consisting of five biomarkers in the blood was significantly associated with progression-free survival (PFS) in mRCC patients treated with everolimus (7–9). The systemic inflammation response index based on widely available laboratory findings (hemoglobin concentration and lymphocyte-to- monocyte ratio) predicts OS and seems to be a better option (10).…”

Section: Introductionmentioning

confidence: 99%

Predictive Factors for Second-Line Therapy in Metastatic Renal Cell Carcinoma: A Retrospective Analysis

Eggers

Ivanyi

Hornig

et al. 2017

jkcvhl

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Currently, about 50% of patients with metastatic renal cell carcinoma (mRCC) receive a second-line therapy. Therefore, the choice at each subsequent treatment line remains an important issue. In this retrospective study, we sought to identify pretreatment clinical parameters that could predict the likelihood of a patient receiving a second-line therapy. One hundred and sixty-one mRCC patients who received targeted therapy were evaluated. Descriptive statistics, Kaplan–Meier overall survival (OS), Cox regression, and binary logistic regression models were used for data analysis. Second-line therapy was given to 105 patients (65%). Patients with grade 1 tumor received second-line therapy more frequently than those with grade 2/3 tumors (P = 0.03). Only tumor grade was significantly different between patients receiving, or not receiving, second-line treatment. Median OS was significantly superior in patients receiving second-line therapy (32 versus 14 months; P = 0.007; hazard ratio [HR], 1.75; P = 0.008), patients with grade 1 tumors (130 versus 29 months in G2/3 tumors; HR, 3.85; P = 0.009), and in patients without early tumor progression (41 versus 11 months; HR, 5.04; 95% confidence interval [CI], 3.06–8.31; P < 0.001). In binary logistic regression, we identified early progression to be significantly associated with a higher probability of not receiving a second-line therapy (HR, 2.50; 95% CI, 1.01–6.21; P = 0.048). This study hypothesizes that pretreatment grade and early progression are predictive parameters for the selection of patients for second-line therapy.

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Metastatic Tumor Burden Does Not Predict Overall Survival Following Cytoreductive Nephrectomy for Renal Cell Carcinoma: a Novel 3-Dimensional Volumetric Analysis

Cited by 5 publications

References 20 publications

An evaluation of the role of tumor load in cytoreductive nephrectomy

An evaluation of the role of tumor load in cytoreductive nephrectomy

The Association Between Small Primary Tumor Size and Prognosis in Metastatic Renal Cell Carcinoma: Insights from Two Independent Cohorts of Patients Who Underwent Cytoreductive Nephrectomy

Predictive Factors for Second-Line Therapy in Metastatic Renal Cell Carcinoma: A Retrospective Analysis

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