Mortality risk in clinical T1a renal cell carcinoma (RCC) with synchronous metastasis (SM): A comparative analysis of National Cancer Database (NCDB).

• DOI: 10.1200/jco.2025.43.5_suppl.513
• Publication Date: 2025-02-18T14:40:47Z
• Authors: Melis Gür; Luke Wang; Franklin Liu; Dhruv Puri; Margaret F. Meagher; Juan Javier-Desloges; James Murphy; Brent S Rose; Aditya Bagrodia; Ithaar Derweesh; Rana R. McKay
• Keywords: Distant metastasis; Kidney cancer

513 Background: The incidence of RCC has been rising, largely due to increased incidental detection from widespread imaging. Although SM with a primary renal tumor measuring <4 cm (cT1a) is uncommon, its presence may influence survival outcomes and utility cytoreductive nephrectomy. We sought examine trends, metastatic patterns, treatments cT1a SM. Methods: All cases (age ≥ 18 years), diagnosed between 2004-2019, were extracted the NCDB. Cochran-Armitage test was utilized for trend analyses. Multivariable analyses conducted compare variables associated all-cause mortality across sites. Results: Overall, 263,911 patients T1a included in analysis. Of these, 114,661 (43.4%) had stage within this group, 2,275 (2.0%) presented From proportion decreased 3.39% 2.08% (AAPC=-0.037%; p=0.830). median follow-up 8.8 months. most common site metastasis bone (59%), followed by lung (35%), liver (16%), brain (12%). Among patients, 11% underwent radical nephrectomy, 4.7% partial 15.4% metastasectomy, 45.2% received systemic therapy. Variables demonstrated table. Conclusions: Uniquely, synchronous metastasis, contrasting typical predominance larger tumors. Primary resection receipt therapy showed potential benefits isolated metastases, while metastasectomy improved brain-only metastases but not bone-, lung-, or liver-only metastases.These findings highlight heterogeneous nature biology small masses underscore importance tailored, multimodal treatment strategies effective management Cox regression models demonstrating lung, bone, liver, brain. Lung Bone Liver Brain HR (95% CI) p-value Age 0.98 (0.96-1.01) 0.178 1.03 (1.02-1.04) <0.001 1(0.97- 1.03) 0.989 0.99(0.96- 0.748 Surgery Site Nephrectomy 0.08(0.01- 0.72) 0.047 0.35(0.14- 0.86) 0.056 0.22(0.06-0.78) 0.039 0.08(0.02- 0.41) 0.005 Partial 0.02(0.00- 0.31) 0.013 0.23(0.09- 0.60) 0.011 0.13(0.01- 2.35) 0.165 0.1(0.01- 0.97) Metastasectomy 0.91(0.50- 1.67) 0.759 0.81(0.59- 1.10) 0.169 3.14(0.90- 11.0) 0.074 0.26(0.10- 0.68) 0.006 Systemic Therapy 0.36(0.23-0.57) 0.57(0.44- 0.74) 0.41(0.20- 0.85) 0.033 0.22(0.10- 0.48) = hazard ratio, CI confidence interval.