MP12-09: Prognostic model of upfront cytoreductive nephrectomy in patients with metastatic renal cell carcinoma treated with immune-checkpoint inhibitors and/or tyrosine kinase inhibitors.

Jun Teishima*, Keisuke Goto, Yohei Sekino, Tetsutaro Hayashi, Nobuyuki Hinata, Hiroshima, Japan

Introduction: The aim of this study was to investigate the prognostic factor and to establish the prognostic model using them of upfront cytoreductive nephrectomy (CN) in patients with metastatic renal cell carcinoma (mRCC) treated with immune checkpoint inhibitor (ICI) and/or tyrosine kinase inhibitor (TKI).

Methods: Four hundred patents with mRCC treated with TKI and/or ICI were classified into 3 groups; those undergoing CN (upfront CN group, 117 cases), those who initially underwent systemic therapy (non-upfront CN group, 94 cases), and those whose recurrence were pointed out after radical nephrectomy (RN) (RN group, 189 cases). In upfront CN group, patients’ background and overall survival (OS) was compared with those in other two groups, and prognostic factors were analyzed. Prognostic model of upfront CN group was established.

Results: Median of the observation period in upfront CN group was 25 months. The rate of patients with clear cell histology, Karnofsky performance status (KPS) =80%, single metastatic organ, normal pretreated C-reactive protein level and intermediate risk in IMDC model were significantly higher than those in non-CN group (87.2% and 30.9%, p< 0.0001; 92.3% and 77.7%, p=0.0025; 41.9% and 24.5%, p=0.0080, 47.9% and 13.8%, p<0.0001; 66.7% and 45.7%, p=0.0023, respectively). 50%OS in upfront CN group was 33.1months, significantly better than that in non-upfront CN group (11.1 months, p<0.0001), and these results were consistent regardless of their prognostic risk level. Multivariate analysis showed that multiple metastatic organs and KPS <80% were independent predictive factors for OS (Hazard ratio; 1.653 and 2.995, p=0.0339 and 0.0054, respectively). Using these two parameters to stratify upfront CN group, 50%OS in cases with no risk factor, that with one factor and that with two factors were 43.4 months, 29.1 months, and 7.7 months, respectively (p < 0.0001).

Conclusions: Upfront CN group is able to be stratified by our prognostic model into three subgroups with different prognosis. This model can provide us useful information for making a decision of considering upfront CN in patients with mRCC.

Source of Funding: None.