MP47-18: Sustainable multidisciplinary team referral for non-metastatic renal cell carcinoma: a survival-based recommendation

Giuseppe Basile*, Alberto Martini, Giuseppe Fallara, Antony Pellegrino, Alessandro Larcher, Daniele Raggi, Milan, Italy, Riccardo Campi, Florence, Italy, Sumanta Pal, Duarte, CA, Philippe Spiess, Tampa, FL, Francesco Montorsi, Milan, Italy, Toni K. Choueiri, Boston, MA, Andrea Necchi, Umberto Capitanio, Milan, Italy

Introduction: To date, multidisciplinary team (MDT) evaluation, enrollment in pre-surgical trials and deferred active treatments are optional strategies for patients with Renal Cell Carcinoma (RCC), which are under investigation to maximize cancer control and implement health care policies. To provide recommendations regarding which patients with RCC may benefit the most from an early MDT evaluation.

Methods: We relied on a prospective dataset including patients diagnosed with RCC in 1998-2019 and treated by means of surgery alone at a tertiary referral center. The risk of other cause mortality (OCM) was evaluated against the risk of recurrence over time by means of the Weibull regression. Patients were stratified based on clinical stage (cT1a; cT1b; cT2; cT3-4), age ( <60; 60-70; >70) and comorbidities [Charlson comorbidity index (CCI) 0 vs =1]. For each combination of cT stage, age and CCI, the potential need for a MDT referral was defined when the risk of recurrence exceeded the risk of OCM within the lower limit of the 95%CI of the mean time to recurrence.

Results: Overall, 1,162 (51%) patients had no comorbidities. Median follow-up was 7 years. Patients who would benefit most from a MDT evaluation are those diagnosed with A) cT3-4 disease (any age or comorbidity) or B) cT2 cancers if healthy and younger than 70 years or younger than 60 years with at least 1 comorbidity or C) cT1b if younger than 60 years and without comorbidities. Figure 1 depicts the risk of other cause mortality versus risk of recurrence following surgery for non-metastatic renal cell carcinoma according to age and cT stage in patients with no comorbidities or in presence of comorbidities.  The continuous lines depict the risk of recurrence that decreases with time. Vertical lines depict the mean time to recurrence and associated 95% confidence interval calculated with mean restricted survival time. Dashed lines depict other cause mortality risk, which increases with time.

Conclusions: Our findings can help selecting the optimal candidates for multidisciplinary evaluations and to consider RCC patients for clinical trials, deferred treatment, and treatment policy improvement, especially in the case of major healthcare disruptions, such as pandemics.

Source of Funding: no