Peritoneal metastases (PM) have been reported in approximately 1% of patients with metastatic Renal Cell Carcinoma (mRCC). Outcome data are limited due to the rarity of this metastatic site. Therefore, the aim of our study is to describe renal cell carcinoma (RCC) patients with PM treated as per clinical practice. Baseline characteristics and outcome data of patients with PM from RCC were retrospectively collected from 18 Italian oncological referral centers adhering to the Meet-Uro group, from January 2016 to January 2023. We collect 81 RCC patients with PM. 78/81 received systemic treatment, 3/81 only best supportive care. First line treatment included tyrosine-kinase inhibitors (TKI) (46/78), ImmuneOncology (IO)-TKI (26/78) and IO-IO (6/78), with different Objective Response Rate (ORR) (43.4% in TKI monotherapy group vs 50% in IO-TKI group, respectively) and Disease Control Rate (DCR) (60.8% in TKI treated patients vs. 76.9% in IO-TKI treated patients). Median PFS was 6.4 months (95%CI 4.18-14.8) in patients treated with TKI monotherapy vs 23.7 months (95%CI 11.1-NR) in patients treated with IO-TKI ( < 0.015). The median OS (mOS) was 22.7 months (95%CI 13.32 – 64.7) in the TKI monotherapy group vs 34.5 mo (95%CI NR-NR) in the IO-TKI group with 53.8% of patients alive at 1 years in the latter group, ( < 0.16). Primary refractory patients were 36.9% for TKI and 15.3% for IO-TKI. According to International Metastatic renal cell carcinoma Database Consortium (IMDC) score, mPFS and mOS were consistent among risk categories. Median PFS was 36.6 months (95%CI 10.9-NR) for good risk patients compared to 10 months (95%CI 7.5-29.8) for intermediate risk and 2.96 months (95%CI 2.43-11.28) for poor risk population ( < 0.0005) whereas mOS was NR (95%CI 28.65-NR) for good risk patients compared to 35.3 months (95%CI 24.6-NA) and 12.4 months (95%CI 3.52-NR) for intermediate and poor risk population, respectively, ( < 0.0002). Only 34/78 (43.5%) received a second line treatment that was TKI (ORR 8.3% and DCR 41.6%) or IO (ORR 18.1% and DCR 40.9%). We report one of the largest case series regarding PM from RCC. Characteristics of patients suggest a more aggressive behavior of PM from mRCC. Outcome data suggest that TKI-IO as first line treatment, and TKI as second line, confirm their activity for these patients with dismal prognosis.

中文翻译：

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肾细胞癌腹膜转移的真实世界分析。遇见-Uro27

据报道，约 1% 的转移性肾细胞癌 (mRCC) 患者出现腹膜转移 (PM)。由于该转移部位的稀有性，结果数据有限。因此，我们研究的目的是描述根据临床实践治疗的肾细胞癌 (RCC) 患者的 PM。从 2016 年 1 月至 2023 年 1 月，从 Meet-Uro 小组所属的 18 个意大利肿瘤转诊中心回顾性收集了 RCC 伴 PM 患者的基线特征和结果数据。我们收集了 81 名伴 PM 的 RCC 患者。 78/81 接受全身治疗，3/81 仅最佳支持治疗。一线治疗包括酪氨酸激酶抑制剂 (TKI) (46/78)、ImmuneOncology (IO)-TKI (26/78) 和 IO-IO (6/78)，具有不同的客观缓解率 (ORR)（43.4%） TKI 单药治疗组与 IO-TKI 组分别为 50%）和疾病控制率 (DCR)（TKI 治疗患者为 60.8%，IO-TKI 治疗患者为 76.9%）。接受 TKI 单药治疗的患者的中位 PFS 为 6.4 个月 (95% CI 4.18-14.8)，而接受 IO-TKI 治疗的患者的中位 PFS 为 23.7 个月 (95% CI 11.1-NR) ( < 0.015)。 TKI 单药治疗组的中位 OS (mOS) 为 22.7 个月 (95% CI 13.32 – 64.7)，而 IO-TKI 组为 34.5 个月 (95% CI NR-NR)，其中 53.8% 的患者在 1 年时存活后一组，（<0.16）。原发性难治性患者接受 TKI 治疗的比例为 36.9%，接受 IO-TKI 治疗的原发难治性患者的比例为 15.3%。根据国际转移性肾细胞癌数据库联盟 (IMDC) 评分，mPFS 和 mOS 在风险类别之间保持一致。良好风险患者的中位 PFS 为 36.6 个月 (95%CI 10.9-NR)，而中等风险患者为 10 个月 (95%CI 7.5-29.8)，低风险人群为 2.96 个月 (95%CI 2.43-11.28) (< 0.0005) ）而高危患者的 mOS 为 NR（95%CI 28.65-NR），而中危和低危人群的 mOS 分别为 35.3 个月（95%CI 24.6-NA）和 12.4 个月（95%CI 3.52-NR），（ < 0.0002)。只有 34/78 (43.5%) 接受二线治疗，即 TKI（ORR 8.3% 和 DCR 41.6%）或 IO（ORR 18.1% 和 DCR 40.9%）。我们报告了有关 RCC 的 PM 的最大案例系列之一。患者的特征表明 mRCC 的 PM 具有更具攻击性的行为。结果数据表明，TKI-IO 作为一线治疗，TKI 作为二线治疗，证实了它们对这些预后不佳的患者的活性。