Prognostic model of renal cell carcinoma with recurrence after radical surgery treated with systemic therapy using immune-checkpoint inhibitors and/or tyrosine kinase inhibitors: A multicenter retrospective study

Purpose: Advanced renal cell carcinoma (RCC) has 2 classifications: cases that have recurred after radical surgery and cases that have metastasis at the initial diagnosis. This study clarified the predictive factors for the prognosis of patients with advanced RCC that recurred after radical surgery. Materials and methods: We retrospectively studied 146 patients who experienced a relapse of RCC after radical surgery and who had been treated with combined immunotherapy or tyrosine kinase inhibitors (TKIs) at Kobe University and affiliated institutions since 2016. The association between clinicopathological characteristics and overall survival (OS) was analyzed. Results: First-line treatment was combined with immunotherapy in 74 cases and TKIs in 72 cases. Multivariate analyses revealed that age greater than 70 years and bone metastasis were independent predictive factors for worse OS. Using these 2 parameters to stratify the 146 patients, the OS in cases with one risk factor was significantly worse than that with no risk factor ( P = 0.0149) and significantly better than with 2 risk factors ( P = 0.0220), while no significant difference was found in the OS between intermediate risk and poor risk in the International Metastatic Renal Cell Carcinoma Database Consortium criteria ( P = 0.2949). In cases with 1 or 2 factors, OS in cases treated with combined immunotherapy was significantly better than in cases treated with TKIs ( P = 0.0337). Conclusion: Advanced RCC that recurred after radical surgery can be stratified by different parameters other than the International Metastatic Renal Cell Carcinoma Database Consortium criteria, which may provide useful information for treatment selection.