Abstract: PD04-08
Sources of Funding: none

Introduction

In the targeted therapy era, many questions remain unanswered regarding the surgical management of metastatic renal cell carcinoma (mRCC). While currently there appears to be evidence to suggest a survival benefit from cytoreductive nephrectomy (CN), little is known about the survival benefit of CN combined with metastasectomy in the targeted therapy era.

Methods

From an institutional database of 2,906 patients surgically treated for renal masses between 2005 and 2016, we identified 80 patients with mRCC who underwent CN, 44 of whom also underwent a metastasectomy. Cox regression analysis was used to evaluate the survival benefit of metastasectomy combined with CN compared to CN alone. Additionally, we identified patients who achieved an R0 resection with metastasectomy.

Results

44 patients underwent a total of 54 metastasectomies. 25.9% of removed metastases were bone lesions, 20.3% were adrenal, 12.9% were lung, and 12.9% were brain. Examining the temporal relationship of metastasectomy and CN, we found that 22.2% of metastasectomies occurred prior to CN, while 42.5% and 35.1% had resections during and after CN, respectively. Having a metastasectomy was associated with improved overall survival (HR=0.53, p=0.02, 95% CI 0.31-0.92). Additionally, achieving an R0 status after metastasectomy achieved and even greater survival benefit compared to non-R0 metastasectomy and CN alone (HR=0.26, p=0.006, 95% CI (0.1-0.69) (Figure 1).

Conclusions

Metastasectomy in the setting of CN was associated with improved overall survival in the targeted therapy era. Furthermore, the principle of achieving even greater cancer control, and thus improved overall survival, with an R0 resection holds firm.

Funding

none