Time from nephrectomy as a prognostic factor in metastatic renal cell carcinoma patients receiving targeted therapies : overall results from a large cohort of patients

Objective: To investigate whether time from nephrectomy (Nx) to the diagnosis of metastatic disease may be an independent prognostic factor in metastatic renal cell carcinoma (mRCC) patients treated with targeted therapies (TTs). Subjects and Methods: All patients who underwent Nx and at least 1 TT were considered. The patients were divided into two groups based on time from Nx [>1 year (Nx >1) and <1 year (Nx <1)] and a third group for cytoreductive Nx (cNx). Median overall survival (OS) represented the primary outcome. Results: A total of 297 patients met the inclusion criteria. The time from Nx was >1 year in 47%, <1 year in 26% and concomitant with the diagnosis of metastatic disease in 27% of the cases (i.e. cNx). The median OS was 40.6 months (95% CI 30.5-50.7) for the Nx >1 group, 24.3 months (95% CI 17.7-31) for the Nx <1 group and 16.2 months (95% CI 11.2-21.3) for the cNx group (p < 0.05 for all comparisons). On multivariate analysis, time from Nx resulted to be an independent prognostic factor (Nx <1 vs. cNx: HR = 0.62, 95% CI 0.42-0.90, p = 0.13; Nx >1 vs. cNx: HR = 0.43, 95% CI 0.31-0.61, p < 0.001). Conclusion: We report that time from Nx is an independent prognostic factor for OS in patients affected by mRCC treated with TTs.