490 Background: Two randomized trials demonstrated survival benefits associated with cytoreductive nephrectomy (CN) for metastatic renal cell carcinoma (mRCC) in the interferon era. However, the role of CN in the era of targeted therapies is yet to be defined. In recent years, neutrophil-to-lymphocyte ratio (NLR) has emerged as a clinically useful prognostic marker in several cancers including mRCC. In this multi-center retrospective study, we aim to assess the impact of CN in mRCC and the value of NLR in risk stratification and patient selection. Methods: Patients with de novo mRCC diagnosed between 2006 and 2012 from three large Australian hospitals were identified using an electronic database. Data regarding clinicopathological features, MSKCC risk group, NLR at the time of metastatic diagnosis, treatments received and survival were collected. NLR ≥5 was used as the cutoff for statistical analyses. Survival analyses were performed using the Kaplan-Meier method and compared using the log-rank test. Multivariate analyses used the Cox proportional hazards method. Results: Our study identified 91 de novo mRCC patients. CN was performed in 46 (51%) patients. Patients who underwent CN were more likely to be younger (median age 59.0 vs. 64.6, p=0.019), and to have received systemic therapy post CN (91% vs. 76%, p=0.043). Median overall survival (mOS) was significantly improved in patients who underwent CN (23.0 mo vs. 10.9 mo, p=0.039). Patients with NLR <5 also had superior mOS (16.7 mo vs. 6.2 mo; HR 0.53; 95% CI; 0.24-0.84; p=0.013). While CN was associated with substantially improved survival in patients with both NLR <5 (mOS 31.1 mo vs. 7.0 mo; HR 0.41; 95% CI, 0.18-0.64; p=0.0009) and NLR ≥5 (mOS 10.9 mo vs. 2.3 mo; HR 0.33; 95% CI, 0.11-0.69; p=0.009), the absolute survival difference was greater in patients with baseline NLR <5. Significant survival benefits associated with CN were maintained in multivariate analyses (HR 0.31; 95% CI, 0.18-0.55; p<0.0001). Conclusions: CN is associated with significantly improved OS in de novo mRCC. The incremental survival benefit associated with CN was seen irrespective of NLR.
Delayed Cytoreductive Nephrectomy Following Three Years of Targeted Therapy for Metastatic Renal Cell Carcinoma