Survival outcomes for stage II and III medullary renal cancer patients treated with perioperative chemotherapy: A retrospective analysis.

Abstract

e16526 Background: Medullary renal cancer (MRC) is a rare, aggressive histological subtype of renal carcinoma associated with poor prognosis. The potential survival benefit of perioperative chemotherapy in patients with stage II and III MRC remains unclear. This study investigates survival outcomes for patients treated with surgery alone or in combination with perioperative chemotherapy. Methods: We conducted a retrospective analysis using the National Cancer Database (NCDB) from 2004 to 2021. Patients with MRC (histology code 8510) were included if they had stage II or III disease and underwent nephrectomy. Perioperative chemotherapy was defined as administration before or within 60 days after surgery. Kaplan-Meier survival curves and log-rank tests compared overall survival (OS) between treatment groups, while a Cox proportional hazards model evaluated the impact of stage, age, sex, treating facility, and comorbidities on survival. Results: A total of 65 stage II and III patients met inclusion criteria, with 42 receiving surgery alone and 23 receiving perioperative chemotherapy. The combined cohort had a median OS of 20.21 months (95% CI: 14.95–28.29). Among stage II patients (n = 3), the median OS was 23.85 months (95% CI: 23.85–NA), while stage III patients (n = 62) had a median OS of 18.50 months (95% CI: 14.95–28.29). Comparing treatment groups, the surgery-alone group had a median OS of 20.50 months (95% CI: 14.92–33.87), and the surgery + chemotherapy group had a median OS of 20.21 months (95% CI: 10.38–NA). Kaplan-Meier analysis showed no significant survival difference between the two groups (log-rank p = 0.7). Multivariate Cox regression analysis revealed that none of the evaluated factors significantly influenced survival. This included stage (HR = 2.71, p = 0.4), age (HR = 0.95, p = 0.059), sex (HR = 0.79, p = 0.5), treating facility type (HR = 1.72 for non-academic vs. academic, p = 0.4), and comorbidities (HR = 1.09, p = 0.8). Conclusions: This retrospective study highlights the poor prognosis of stage II and III MRC, with a combined median OS of 20.21 months. The addition of perioperative chemotherapy did not provide a significant survival benefit compared to surgery alone. None of the evaluated clinical or demographic factors, including stage, age, or comorbidities, showed significant prognostic value in this cohort. These findings underscore the need for further research into novel systemic therapies to improve outcomes in this rare and aggressive disease.