Cytoreductive nephrectomy: Are CARMENA outcomes the norm?
BAUS ePoster online library. Brousil P. Jun 25, 2019; 259585; P8-9 Disclosure(s): No disclosures
Mr. Philip Brousil
Mr. Philip Brousil
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Abstract
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INTRODUCTION

The CARMENA trial challenges the established paradigm for upfront cytoreductive nephrectomy (CN) in the management of metastatic renal cell carcinoma. However questions remain about the generalizability of these outcomes to non-trial patients.
Methods
Retrospective review of outcomes of patients undergoing CN in a single centre since 2013. Risk stratification assessed by Heng criteria; performance status by Karnofsky; complications by Clavien-Dindo; overall survival by Kaplan-Meier. Clinical features, risk stratification and outcomes were compared with the CARMENA trial cohorts.
Results
54 patients. 35% female. 50/54 (93%) underwent upfront open CN; 3/54(6%) CN post-TKI (Tyrosine Kinase Inhibitor). Variant histology in 6/54 (11%). 1/54 (2%) died within 30 days of surgery: this was the only case where the CN was abandoned. 5/54 (9%) had ≥ Clavien-Dindo 3 complications (vs 16% CARMENA).
Clinical features and risk stratification are shown in table 1.
Headline results:
1. Risk stratification: Poor prognosis 23% versus 44% in CARMENA
2. 3/54 (6%) too unwell to receive post-operative TKIs (18% in CARMENA did not receive post-operative TKIs).
3. Median survival 37.6 months (versus 13.9 months/Surgical arm & 18.4 months/TKI only arm of CARMENA).
4. 8/54 patients (15%) of the cohort have not needed TKI therapy to date.

CONCLUSION

In a contemporary UK population undergoing cytoreductive nephrectomy; performance status, tumour stage, risk stratification, and outcomes are markedly different from those in the CARMENA trial. The generalisability of the CARMENA trial outcomes and recommendations is questionable.
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