Who Benefits Most from Multidisciplinary Evaluations at RCC Diagnosis?


For patients with renal cell carcinoma (RCC), a multidisciplinary team (MDT) approach, along with enrollment in trials assessing the role of deferred active treatments and perioperative therapies, are customary. However, due to an increased risk for recurrence relative to the risk for dying of other causes, Alberto Martini, MD, and colleagues identified subgroups of patients with RCC who might benefit from an early referral at diagnosis for MDT assessment.

For a study published in Urologic Oncology: Seminars and Original Investigations, the researchers analyzed prospective data for patients diagnosed with RCC from 1998-2019 who underwent surgery alone at a tertiary referral center. “To identify those patients who might benefit the most from an MDT approach before any clinical decision is made from those who might be cured with surgery alone, we created a model that weighed the risk of [disease-free survival (DFS)] and [other case mortality (OCM)] over time according to age, comorbidity, and cancer stage,” the study authors wrote.

 

Determining Who Benefits from Early Evaluation

Utilizing the Weibull regression model, risk for OCM was assessed against the risk for distant metastasis. Patients were classified by RCC clinical stage (cT3-4, cT2, cT1b, or cT1a), comorbidities, and age (<60, 60–70, >70); 51% of patients had no comorbidities.

Need for MDT referral was based on risk for recurrence exceeding risk for OCM within the lower limit of the 95% CI of the mean time to recurrence for each combination of cT stage, age, and Charlson Comorbidity Index, Dr. Martini and team explained.

 

MDT Useful During Major Healthcare Disruptions

Dr. Martini and colleagues isolated certain characteristics of patients who would best benefit from an MDT evaluation at diagnosis. These characteristics included a diagnosis of:

  1. Stage cT3-4 disease (any age or comorbidity)
  2. Stage cT2 disease if healthy and younger than 70 or younger than 60 with at least one comorbidity
  3. Stage cT1b disease if younger than 60 and without comorbidities.

“Clinical characteristics at diagnosis of non-metastatic RCC can help identify those patients who might benefit the most from a multidisciplinary evaluation to assess the appropriateness of alternative approaches to surgery alone and those who might be cured with surgery alone,” the study authors wrote. They added that this approach can be especially useful during the current pandemic, when access to treatment can be delayed.



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