Risk Factors for First-Year Recurrence in Patients With Synchronous Metastatic Renal Cell Carcinoma Undergoing...

Area of Science:

• Urology and Oncology
• Surgical Oncology
• Medical Oncology

Background:

• Metastatic renal cell carcinoma (mRCC) patients with oligometastatic disease can achieve radiographic complete remission (M1 NED) after cytoreductive nephrectomy and metastasectomy.
• Identifying patients at high risk for recurrence is crucial for optimizing post-surgical management.

Purpose of the Study:

• To evaluate outcomes in mRCC patients who achieved M1 NED status post-surgery.
• To identify risk factors for metastatic recurrence and overall survival in this cohort.

Main Methods:

• Retrospective analysis of 109 mRCC patients from four institutions (2010-2020) who achieved M1 NED.
• Kaplan-Meier survival analysis and logistic regression modeling to identify recurrence predictors.
• Decision curve analysis to assess a prognostic model's clinical utility.

Main Results:

• 36 patients experienced recurrence within the first year, while 73 had delayed or no recurrence.
• First-year recurrence was associated with significantly shorter overall survival (15 vs 97 months, P < .0001).
• Predictors of first-year recurrence included liver metastases, larger primary tumor size, and elevated preoperative C-reactive protein.

Conclusions:

• Liver metastasis, primary tumor size, and C-reactive protein predict early recurrence after cytoreductive surgery for mRCC.
• High-risk patients achieving M1 NED status may benefit from immediate post-operative systemic therapy due to poor outcomes associated with early recurrence.