Risk Factors for First-Year Recurrence in Patients With Synchronous Metastatic Renal Cell Carcinoma Undergoing Cytoreductive Nephrectomy and Complete Metastasectomy.

Abstract

Patients with metastatic renal cell carcinoma (mRCC) with oligometastatic disease can achieve radiographic disease-free (M1 NED) status after cytoreductive nephrectomy and concurrent complete metastasectomy. This study aimed to evaluate outcomes and identify risk factors associated with metastatic recurrence and overall survival in patients with mRCC M1 NED. Patients with synchronous mRCC who were M1 NED after cytoreductive nephrectomy and concurrent complete metastasectomy from 4 institutions (2010-2020) were identified. Survival outcomes were analyzed by the Kaplan-Meier method. Patients were grouped by early (first year after surgery) recurrence or delayed/no known metastatic recurrence. Logistic regression modeling identified risk factors for first-year recurrence, and decision curve analysis evaluated the utility of a model incorporating identified risk factors. One hundred and nine M1 NED patients were identified including 36 patients who had recurrence in the first year after surgery and 73 patients with delayed or no recurrence. First-year recurrence resulted in significantly shorter overall survival compared with those with delayed/no recurrence after 1 year (median 15 vs 97 months, respectively, <i>P</i> < .0001). First-year recurrence predictors included liver metastases, increasing primary tumor size, and elevated preoperative C-reactive protein. A prognostic model incorporating these factors demonstrated discriminatory capacity and improved clinical decision-making compared with a universal immediate postoperative systemic therapy or active surveillance strategy. Liver metastasis, increasing primary tumor size, and elevated preoperative C-reactive protein are associated with increased risk for first-year progression after cytoreductive nephrectomy and complete metastasectomy. Despite radiographic NED status, high-risk patients should be considered for immediate systemic therapy after surgery given poor outcomes.