Liver metastasis, tumour size predict recurrence in patients with mRCC after surgery

In patients with synchronous metastatic renal cell carcinoma (mRCC), factors such as liver metastasis, increasing primary tumour size, and elevated preoperative C-reactive protein (CRP) predict the risk of first-year progression following cytoreductive nephrectomy and complete metastasectomy, suggests a recent study.

A total of 109 patients with synchronous mRCC who achieved radiographic disease-free (M1 NED) status after cytoreductive nephrectomy and complete metastasectomy from institutions were included in this study. The Kaplan-Meier method was used to analyse survival outcomes.

The authors grouped the patients by early (first year after surgery) recurrence or delayed/no known metastatic recurrence. They performed logistic regression to identify the risk factors for first-year recurrence and decision curve analysis to assess the utility of a model incorporating these risk factors.

Of the patients, 36 had recurrence in the first year after surgery, and 73 had delayed or no recurrence. First-year recurrence led to shorter overall survival compared with delayed or no recurrence after 1 year (median 15 vs 97 months; p<0.0001).

Predictors of recurrence within 1 year after surgery included liver metastases, increasing primary tumour size, and elevated preoperative CRP. A prognostic model that incorporates these factors showed discriminatory capacity and improved clinical decision-making relative to a universal immediate postoperative systemic therapy or active surveillance strategy.

“Despite radiographic NED status, high-risk patients should be considered for immediate systemic therapy after surgery given poor outcomes,” the authors said.