Real-world, retrospective data showed that morphologic renal cell carcinoma types and tumor-stages helps to inform recurrence and prognosis.
Real-world, retrospective data showed that morphologic renal cell carcinoma (RCC) types and tumor-stages helps to inform recurrence and prognosis. Investigators evaluated disease-free survival (DFS) and overall survival (OS) rates measured at 2 and 5 years, according to findings presented in a poster at the 2024 ASCO Genitourinary Cancers Symposium.1
“Our study provides real-world recurrence and survival rates, [however], a major limitation is the retrospective nature of the analysis,” investigators wrote in the poster.
The real-world data were organized in 3 main groups based on stage 1, 2, or 3 of tumor node metastasis (TNM) and histology: clear cell renal cell carcinoma (ccRCC), papillary renal cell carcinoma (pRCC), and not otherwise specified (NOS).
Patients in the ccRCC group with TNM stage 1 showed at 2 years a DFS of 90.4% (CI 95%, 87.1%-94%) and at 5 years 78.9% (CI 95%, 73.6%-84.5%). The OS for this group was 95.2% (CI 95%, 93.2%-97.2%) at 2 years and 86.5% (CI 95%, 82.8%-90.4%) at 5 years. These percentages decrease per TNM stage, and patients with ccRCC TNM stage 3 showed a DFS of 70.6% (CI 95%, 61.1%-81.5%) at 2 years and 46.5% (CI 95%, 34.9%-62.1%) at 5 years and an OS of 89.3% (CI 95%, 83.7%-95.2%) at 2 years and 70% (CI 95%, 60.2%-81.3%) at 5 years.
For patients in the pRCC group with TNM stage 1, the DFS was 93.9% (CI 95%, 89.2%-98.8%) at 2 years and 88.5% (CI 95%, 81.0%-97.8%) at 5 years. The OS was 94.8% (CI 95%, 91.1%-98.6%) at 2 years and 88% (CI 95%, 82.2%-94.2%) at 5 years. For patients in this group with TNM stage 3, the DFS at 2 years was 47.1% (CI 95%, 26.5%-83.8%) and 23.6% (CI 95%,7.6%-73.4%) at 5 years and the OS at 2 years was 70.4% (CI 95%, 51.5%-96.2%) and 41.1% (CI 95%, 20.5%-82.5%) at 5 years.
In the NOS RCC group with TNM stage 1 the DFS was 89% (CI 95%, 81%-97.8%) at 2 years and 79.7% (CI 95%, 69.1%-92.0%). The OS was 95.4% (CI 95%, 91.1%-99.9%) at 2 years and 85.9% (CI 95%, 77.2%-95.5%) at 5 years. For patients in this group with TNM stage 3 the DFS at 2 years was 73% (CI 95%, 56.5%-94.3%) and 44.6% (CI 95%, 25.3%-78.4%) at 5 years and the OS at 2 years was 84.5% (CI 95%, 71.6%-99.8%) and 53.5% (CI 95%, 43.2%-83.7%) at 5 years.
The total DFS at 5 years for patients with ccRCC was 83.2% (CI 95%, 80.6%-86.9%) and the total OS was 82.7% (CI 95%, 79.2%-86.3%). For patients with pRCC the total DFS at 5 years was 85.9% (CI 95%, 81.2%-90.8%) and the total OS was 82.0% (CI 95%, 75.9%-88.7%). The total DFS at 5 years for patients with NOS was 87.0% (CI 95%, 82.0%-92.5%) and the total OS was 77.2% (CI 95%, 68.8%-86.6%).
The analysis included adult patients who underwent routine care and either nephron-sparing surgery or nephrectomy for non-metastatic RCC at tertiary German cancer centers between the years 2013 and 2022. Patients with clear cell, papillary, or NOS histologies were eligible for inclusion. The primary objective for the review was to assess DFS and OS using Kaplan-Meier analyses stratified by pathological stage.
Among patients evaluated in the review, 1291 received nephron-sparing surgery or nephrectomy and 1271 of these patients (98.5%) had R0 or R1 resection margins. The median follow-up was 37.8 months (interquartile range, 13.08-65.74). Among all patients included in the review, 754 had ccRCC with a mean age of 63.5 years and 70.0% were male. There were 221 patients who had pRCC with a mean age of 62.1 years, and 78.7% were male. There were 165 patients with NOS RCC, a mean age of 63.3 years, and 67.3% were male. Additionally, 129 patients had other histologies, a mean age of 61.0, and 50.4% were male.
In localized RCC, standard treatments include nephrectomy and risk-adapted adjuvant pembrolizumab. The risk of recurrence is assessed based on findings from clinical trials to guide patient counseling. The real-world data are minimal for recurrence and survival and real-world outcomes may vary from what is observed in controlled trial settings. This study presented real-world outcome data of RCC patients sourced from the German Cancer Consortium’s Clinical Communication Platform, which serves as a federated data warehouse infrastructure specifically designed for gathering oncological real-world evidence.
“[Because] our study advises on real-world recurrence and survival rates in patients with different RCC types, it may be used to counsel patients with regards to adjuvant therapy in the clinic,” investigators stated in the abstract.
Advances in Subsequent Therapies Shake Up Sequencing of ccRCC Treatment
April 25th 2024With the approval of belzutifan and other newer data for treating patients with recurrent renal cell carcinoma, the state of subsequent therapies is advancing beyond the reuse of frontline options with impacts on duration of response and quality of life.
Read More
Ornstein Advises on Starting Dose and Management of Lenvatinib in RCC
April 21st 2024During a Case-Based Roundtable® event, Moshe Ornstein, MD, MA, provided guidance on dosing and toxicity concerns in a patient treated with lenvatinib plus pembrolizumab for advanced renal cell carcinoma.
Read More
Enhancing Precision in Immunotherapy: CD8 PET-Avidity in RCC
March 1st 2024In this episode of Emerging Experts, Peter Zang, MD, highlights research on baseline CD8 lymph node avidity with 89-Zr-crefmirlimab for the treatment of patients with metastatic renal cell carcinoma and response to immunotherapy.
Listen
Deciding Factors for Front-Line Therapy in Metastatic RCC
April 17th 2024During a Case-Based Roundtable® event, Shilpa Gupta, MD, led a discussion on what factors influence physician decision making for frontline therapy in patients with metastatic renal cell carcinoma in the first article of a 2-part series.
Read More