Nephrectomy improves overall survival in patients with metastatic renal cell carcinoma in cases of favorable MSKCC or ECOG prognostic features

Romain Mathieu (1) , Géraldine Pignot (2) , Alexandre Ingles (2) , Maxime Crépel (1) , Pierre Bigot (3) , Jean-Christophe Bernhard (4) , Florence Joly (5, 6) , Laurent Guy (7) , Alain Ravaud (8) , Abdel Rahmene Azzouzi (3) , Gwenaëlle Gravis (9) , Christine Chevreau (10) , Laurent Zini (11) , Hervé Lang (12) , Christian Pfister (13) , Eric Lechevallier (14) , Pierre-Olivier Fais (14) , Julien Berger (15) , Bertrand Vayleux (16) , Morgan Rouprêt (17) , François Audenet (18) , Aurélien Descazeaud (19) , Jérôme Rigaud (16) , Jean-Pascal Machiels (20) , Michael Staehler (21) , Laurent Salomon (22, 23) , Jean-Marie Ferrière (4) , François Kleinclauss (24, 25) , Karim Bensalah (26, 27) , Jean-Jacques Patard (28)

1 Service d'urologie [Rennes] = Urology [Rennes]
2 Hôpital Bicêtre
3 CHU Angers - Centre Hospitalier Universitaire d'Angers
4 Service d'urologie, andrologie et transplantation rénale
5 Cancers et préventions
6 UNICANCER/CRLC - Centre Régional de Lutte contre le Cancer François Baclesse [Caen]
7 CHU Clermont-Ferrand
8 CHU Bordeaux [Bordeaux]
9 Institut Paoli-Calmettes
10 Institut Claudius Regaud
11 Hôpital Claude Huriez [Lille]
12 CHU Strasbourg
13 Service d'urologie [Rouen]
14 LA CONCEPTION - Hôpital de la Conception [CHU - APHM]
15 Hôpital Dupuytren [CHU Limoges]
16 CHU Nantes - Centre hospitalier universitaire de Nantes
17 Service d'Urologie [CHU Pitié-Salpêtrière]
18 CHU Pitié-Salpêtrière [AP-HP]
19 Service de Néphrologie, Dialyse, Transplantations [CHU Limoges]
20 Cliniques Universitaires Saint-Luc [Bruxelles]
21 LMU - Ludwig Maximilian University [Munich]
22 Service d'urologie [Mondor]
23 IMRB - Institut Mondor de Recherche Biomédicale
24 RIGHT - Interactions hôte-greffon-tumeur, ingénierie cellulaire et génique - UFC (UMR INSERM 1098)
25 Service d'urologie, andrologie et transplantation rénale
26 CHU Pontchaillou [Rennes]
27 LTSI - Laboratoire Traitement du Signal et de l'Image
28 AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre)

Objectives : The role of cytoreductive nephrectomy (CN) in the treatment of patients harboring metastatic renal cell carcinoma (mRCC) has become controversial since the emergence of effective targeted therapies. The aim of our study was to compare the overall survival (OS) between CN and non-CN groups of patients presenting with mRCC in the era of targeted drugs and to assess these outcomes among the different Memorial Sloan-Kettering Cancer Center (MSKCC) and The Eastern Cooperative Oncology Group (ECOG) performance status subgroups. Methods and materials A total of 351 patients with mRCC at diagnosis recruited from 18 tertiary care centers who had been treated with systemic treatment were included in this retrospective study. OS was assessed by the Kaplan-Meier method according to the completion of a CN. The population was subsequently stratified according to MSKCC and ECOG prognostic groups. Results Median OS in the entire cohort was 37.1 months. Median OS was significantly improved for patients who underwent CN (16.4 vs. 38.1 months, P<0.001). However, subgroup analysis demonstrated that OS improvement after CN was only significant among the patients with an ECOG score of 0 to 1 (16.7 vs. 43.3 months, P = 0.03) and the group of patients with good and intermediate MSKCC score (16.8 vs. 42.4 months, P = 0.02). On the contrary, this benefit was not significant for the patients with an ECOG score of 2 to 3 (8.0 vs. 12.6 months, P = 0.8) or the group with poor MSKCC score (5.2 vs. 5.2, P = 0.9). Conclusions CN improves OS in patients with mRCC. However, this effect does not seem to be significant for the patients in ECOG performance status groups of 2 to 3 or poor MSKCC prognostic group

Keywords: Carcinoma; Nephrectomy; Renal cell; Survival

Domains: Life Sciences [q-bio]; Bioengineering

Romain Mathieu, Géraldine Pignot, Alexandre Ingles, Maxime Crépel, Pierre Bigot, et al.. Nephrectomy improves overall survival in patients with metastatic renal cell carcinoma in cases of favorable MSKCC or ECOG prognostic features. Urologic Oncology: Seminars and Original Investigations, 2015, 33 (8), pp.339.e9-339.e15. ⟨10.1016/j.urolonc.2015.05.014⟩. ⟨hal-01260654⟩