Investig Clin Urol.  2020 Mar;61(2):146-157. 10.4111/icu.2020.61.2.146.

Survival prognoses of Heng intermediate-risk patients with metastatic renal cell carcinoma treated with immunotherapy or targeted therapy: A real-world, single-center retrospective study

• Kim SH
• Lee DE
• Joung JY
• Seo HK
• Lee KH
• Chung J

• KMID: 2471070
• DOI: http://doi.org/10.4111/icu.2020.61.2.146

Abstract

PURPOSE
This study aimed to compare progression-free survival (PFS), overall survival (OS), and cancer-specific survival (CSS) in Heng intermediate-risk patients with metastatic renal cell carcinoma (mRCC) treated with first-line immunotherapy (IT) or targeted therapy (TT).
MATERIALS AND METHODS
From 2000 to 2017, a total of 186 intermediate-risk mRCC patients treated with first-line IT (n=64, 34.4%) or TT (n=122, 65.6%) were retrospectively evaluated for PFS, OS, and CSS using the Kaplan-Meier method with log-rank test and Cox proportional hazards models for their risk factors with a p-value for significance of <0.05.
RESULTS
During a median 5.08-month of systemic treatment and 92.22 months of follow-up, the median PFS, OS, and CSS were 5.16, 18.44, and 19.04 months, respectively. The comparison of baseline characteristics between the two groups showed a significantly higher rate of T3-4 stages, a lower rate of high nuclear grades, shorter follow-up, longer treatment durations, lesser rates of cytoreductive nephrectomy, a lower objective response rate, and no cases of complete response in the TT group compared with the IT group (p<0.05). The survival comparisons between the two groups showed that PFS was significantly different, whereas OS and CSS were not significantly different. The multivariate analyses showed that synchronous metastatic type(hazard ratio [HR], 2.285), IT (HR, 1.746), and treatment-free interval <1 year (HR, 1.926) were significant factors for PFS, whereas none of the risk factors were significant for OS or CSS.
CONCLUSIONS
TT significantly prolonged PFS compared with IT, whereas long-term survival was not significantly different in intermediate-risk mRCC patients.

Keyword

Carcinoma, renal cell; Immunotherapy; Molecular targeted therapy; Neoplasm metastasis; Prognosis

MeSH Terms

Carcinoma, Renal Cell*
Disease-Free Survival
Follow-Up Studies
Humans
Immunotherapy*
Methods
Molecular Targeted Therapy
Multivariate Analysis
Neoplasm Metastasis
Nephrectomy
Prognosis*
Proportional Hazards Models
Retrospective Studies*
Risk Factors

Figure

• 

  Fig. 1 Comparison of (A) overall progression-free survival (PFS), (B) overall survival (OS), and (C) cancer-specific survival (CSS) between immunotherapy (IT) and targeted therapy (TT) in intermediate-Heng-risk patients with metastatic renal cell carcinoma.

• 

  Fig. 2 Comparison of (A–F) treatment-free interval <1 year and ≥1 year and (G–L) either synchronous or metachronous metastatic type of progression-free survival between immunotherapy (IT) and targeted therapy (TT) in intermediate-Heng-risk patients with metastatic renal cell carcinoma. PFS, overall progression-free survival; OS, overall survival; CSS, cancer-specific survival.

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