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Kidney Cancer Subtypes, Tumor Stages May Predict Recurrence, Prognosis

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Real-world data demonstrated that knowing a patient’s stage and subtype of renal cell carcinoma, a type of kidney cancer, may provide cancer teams with the information needed to determine potential prognosis and recurrence risk.

Knowing the specifics of renal cell carcinoma and the disease’s tumor stages may help care teams determine what may be a patient’s prognosis and risk for recurrence, recent study findings suggest.

In these data presented at the 2024 ASCO Genitourinary Cancers Symposium, investigators evaluated disease-free survival (the time after treatment when a patient survives without symptoms or signs of cancer) and overall survival rates (the percentage of patients who are still alive after treatment) measured at two and five years.

“Our study provides real-world recurrence and survival rates, (however), a major limitation is the retrospective nature of the analysis,” researchers wrote in the poster.

Study Highlights:

  • Understanding the specific details of renal cell carcinoma and its different stages can help healthcare teams predict a patient's prognosis and risk of recurrence.
  • Real-world data from a recent study presented at a cancer symposium provides insights into disease-free survival and overall survival rates at two and five years for different stages and types of renal cell carcinoma.
  • The study, although retrospective in nature, used real-world information from a specific institution, offering insights beyond controlled clinical trials.
  • Patients with clear cell renal cell carcinoma generally showed higher survival rates at two and five years in earlier tumor stages, with rates decreasing as the tumor progressed to stage 3.
  • The study included patients who underwent routine care and various surgical options for non-metastatic renal cell carcinoma, offering valuable insights for counseling patients about adjuvant therapy in a real-world clinical setting.

Retrospective studies typically compare two groups of patients: those with the disease and a similar group of people without the disease. In this instance, researchers used real-world data, meaning the patients were cared for at a specific institution not necessarily on the basis of a clinical trial, for instance.

The real-world data were organized in three main groups based on stage 1, 2 or 3 of tumor node metastasis and histology: clear cell renal cell carcinoma, papillary renal cell carcinoma and not otherwise specified.

Patients in the clear cell renal cell carcinoma group with tumor node metastasis stage 1 showed two years of disease-free survival of 90.4% and at five years 78.9%. The overall survival for this group was 95.2% at two years and 86.5% at five years. These percentages decrease per tumor node metastasis stage; patients with clear cell renal cell carcinoma tumor node metastasis stage 3 showed a disease-free survival of 70.6% at two years and 46.5% at five years. These patients also had an overall survival of 89.3% at two years and 70% at five years.

For patients in the papillary renal cell carcinoma group with tumor node metastasis stage 1, the disease-free survival was 93.9% at two years and 88.5% at five years. The overall survival was 94.8% at two years and 88% at five years. For patients in this group with tumor node metastasis stage 3, the disease-free survival at two years was 47.1% and 23.6% at five years; the overall survival at two years was 70.4% and 41.1% at five years.

In the not otherwise specified renal cell carcinoma group with tumor node metastasis stage 1, the disease-free survival was 89% at two years and 79.7%. The overall survival was 95.4% at two years and 85.9% at five years. For patients in this group with tumor node metastasis stage 3, the disease-free survival at two years was 73% and 44.6% at five years; the overall survival at two years was 84.5% and 53.5% at five years.

The total disease-free survival at five years for patients with clear cell renal cell carcinoma was 83.2% and the total overall survival was 82.7%. For patients with papillary renal cell carcinoma, the total disease-free survival at five years was 85.9% and the total overall survival was 82%. The total disease-free survival at five years for patients not otherwise specified was 87% and the total overall survival was 77.2%.

The analysis included adults who underwent routine care and either nephron-sparing surgery (a surgical option for patients eligible for preserving renal function) or nephrectomy (removal of part or all of a kidney) for non-metastatic renal cell carcinoma at cancer centers between 2013 and 2022. Patients with clear cell, papillary or not otherwise specified histologies were eligible for inclusion. The primary objective of the review was to assess disease-free survival and overall survival.

Among patients evaluated in the review, 1,291 received nephron-sparing surgery or nephrectomy and 1,271 of these patients (98.5%) had R0 (no microscopic evidence of a remaining tumor) or R1 resection margins (removal of all macroscopic but not microscopic tumors). The median follow-up was 37.8 months. Among all patients included in the review, 754 had clear cell renal cell carcinoma with a mean age of 63.5 years. There were 221 patients who had papillary renal cell carcinoma with a mean age of 62.1 years. There were 165 patients with not otherwise specified renal cell carcinoma and a mean age of 63.3 years. Additionally, 129 patients had other histologies and a mean age of 61 years.

In localized renal cell carcinoma, standard treatments include nephrectomy and risk-adapted adjuvant Keytruda (pembrolizumab). The risk of recurrence is assessed based on findings from clinical trials to guide patient counseling. The real-world data are minimal for recurrence and survival, and real-world outcomes may vary from what is observed in controlled trial settings.

“(Because) our study advises on real-world recurrence and survival rates in patients with different (renal cell carcinoma) types, it may be used to counsel patients with regards to adjuvant therapy in the clinic,” investigators stated in the abstract.

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