Introduction:

To compare outcomes in high-risk localized RCC (HRL-RCC) patients treated with adjuvant (AT) and neoadjuvant therapy (NT) utilizing a propensity score matched model (PSM)

Methods:

We conducted a multicenter analysis for patients who underwent AT or NT. AT was defined as systemic therapy given postoperatively in absence of metastases; NT was presurgical therapy in setting of localized disease. AT and NT utilized included target molecular therapy (TMT) or immunotherapy (IO). PSM model was conducted using a nearest neighbor matching algorithm in a 1:2 ratio. Primary outcome was all-cause mortality (ACM); secondary outcomes were cancer-specific mortality (CSM) and recurrence. Cox regression multivariable analysis (MVA) was fitted to elucidate predictors of outcomes.

Results:

After PSM 311 patients were analyzed [adjuvant n=221, 127 TMT vs. 94 IO; neoadjuvant n=90, 61 TMT vs. 29 IO]; median follow-up 44 (IQR 20-74) months. MVA revealed AT as associated with increased ACM (HR=1.97, p=0.007), CSM (HR=2.37, p=0.007) and recurrence (HR 1.64, p=0.02). Sub-analysis of AT cohort revealed IO to be associated with decreased ACM (HR 0.59, p=0.015). In the neoadjuvant cohort TMT and IO were associated with decreased ACM (HR 0.49; p=0.016; HR 0.32, p=0.016, respectively) and CSM risk (HR 0.47, p=0.036; HR 0.18, p=0.017).

Conclusion:

Our findings suggest a potential advantage of NT for HRL-RCC. Adjuvant immunotherapy was associated with decreased risk of ACM, while in the neoadjuvant TMT and IO therapy had similar outcomes. Our findings call for consideration of a clinical trial to compare outcomes of AT vs. NT.

Funding: N/A