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High-Risk Locoregional Renal Cell Cancer: S-TRAC Criteria for the Selection of Adjuvant Treatment Candidates

Author(s): Jennifer Brasero Burgos, Victoria Gómez Dos Santos, Sara Álvarez Rodríguez, Pablo Gajate Borau, David Esteban Díaz Pérez, Javier Lorca Álvaro, Marta Santiago González, Víctor Díez Nicolás, Vital Hevia Palacios, Francisco Javier Burgos Revilla  

Introduction and objective: Clear-cell renal-cell carcinoma (RCCcc) is the genitourinary neoplasm with the highest mortality rate despite primary surgical treatment, which highlights the necessity for adjuvant treatment. To date, only the use of sunitinib in the S-TRAC study (Adjuvant Sunitinib in High-Risk Renal-Cell Carcinoma after Nephrectomy) has shown improvement of disease-free survival (DFS). The aim of the present study is to identify, using a single-center sample of patients with locally advanced RCC, potential candidates for adjuvant treatment by the application of the S-TRAC criteria. 

Material and methods: We enrolled patients undergoing oncological nephrectomy from 2009 to 2014. We selected and stratified the patients according to the S-TRAC criteria. DFS and overall survival (OS) were analyzed. 

Results: Forty-eight patients out of the 153 (31.4%) previously selected patients met the S-TRAC inclusion criteria. DFS and OS at 5 years were 73.0% and 71.4%, respectively. According to the UISS prognostic model, 85.4%, 4.1% and 6.2% of our patients were assigned to groups A2, B and C, respectively. DFS in these groups was 73%, 100% and 100%, respectively. OS was 76% in group A2 and 67% in group C. No deaths were observed in group B.

Conclusions: At 5 years, a higher proportion of patients in the present study were disease-free (73.0%) compared to the placebo group of the S-TRAC clinical trial (51.3%). Efforts should be focused on the identification of precise prognostic models in order to identify high-risk candidates to receive adjuvant treatment.

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