(UroToday.com) Dr. Bimal Bhindi presented on the outcomes of a cohort of patients with metastatic renal cell carcinoma (mRCC). Building on the foundation laid by the CARMENA trial—which established that patients with mRCC are typically treated with upfront systemic therapy (ST) rather than cytoreductive nephrectomy (CN)—Dr. Bhindi focused on a different subset: patients who underwent upfront CN with deferred systemic therapy, a group not well-represented in CARMENA.
He began by describing the dataset, which was drawn from the Canadian Kidney Cancer Information System (CKCIS)—a nationally representative, multicenter cohort. His analysis focused on synchronous mRCC patients treated between 2011 and 2024 who had received upfront CN without systemic therapy within the three months prior to surgery. Key outcomes included systemic therapy-free survival (STFS) and cancer-specific survival (CSS), evaluated using Kaplan-Meier curves and multivariable Cox regression models to adjust for survival-related variables.
Dr. Bhindi explained that the study cohort included over 675 patients with a median follow-up of 64 months. Notably, 79% of patients had only a single site of metastasis, and the median dominant metastasis size was 1.8 cm (IQR 1.2–3.0 cm)—features distinct from the CARMENA trial population. He then outlined the key results: the cohort demonstrated a median STFS of 16.7 months, a five-year STFS rate of 25%, and a median CSS of 73.8 months (Figure 1). He also provided important context, noting that much of the data was collected prior to the widespread use of immuno-oncology (IO) therapies, suggesting that contemporary CSS outcomes may now be even higher.
Turning to the multivariable analysis (Figure 2), Dr. Bhindi highlighted variables associated with improved outcomes, including better performance status, absence of venous tumor thrombus, and low metastatic burden—defined as 1–2 non-brain metastatic sites. These factors were independently associated with longer STFS and CSS. He also noted that sarcomatoid dedifferentiation was linked to reduced CSS but not STFS. Regarding the association between dominant metastasis size and STFS, he acknowledged a confounding factor that he offered to discuss offline in the interest of time.
Dr. Bhindi concluded by emphasizing that this study identifies a subset of mRCC patients who may not require immediate systemic therapy following CN. He stressed that their findings do not contradict the results of the CARMENA trial but rather complement them, showing the importance of careful patient selection based on the multivariable analysis. The presentation concluded without additional comments from moderators or audience members.
Figure 1: Cohort Median STFS and CSS
Figure 2: Multivariable Analysis
Presented by: Bimal Bhindi, MD, CM, MSc, FRCSC, University of Calgary, @BBhindi on X, during the 2025 American Urological Association (AUA) Annual Meeting on April 27, 2025, Las Vegas, Nevada
Written by: Harel C. Sims, B.S., University of California Irvine, @SimsHarel on X, during the American Urological Association's 2025 Annual Meeting, between April 26 – 29, 2025 in Las Vegas, NV.
Reference:
- Bhindi B, Mallick R, Tajzler C, Bansal R, Basappa N, Bjarnason G, et al. Mp14-16 Upfront Cytoreductive Nephrectomy With Deferred Systemic Therapy For Metastatic Renal Cell CARCINOMA. Journal of Urology [Internet]. 2025 May 1 [cited 2025 Apr 27];213(5S):e492. Available from: https://doi.org/10.1097/01.JU.0001109872.73672.99.16