# Renal Cell Carcinoma: Characteristics of Patients, Treatment, and Disease Progression Based on Real-World Data From a Cancer Center in Medellín, Colombia

## TL;DR

This study analyzes real-world data from a Colombian cancer center to describe the characteristics, treatment patterns, and survival outcomes of 208 renal cell carcinoma patients.

## Contribution

The study provides the first real-world data on RCC in Colombia, including treatment patterns and survival outcomes in a Latin American context.

## Key findings

- More than half of patients had metastatic disease at diagnosis or developed it later.
- Non-metastatic status, low-risk classification, and first-line tyrosine kinase inhibitors were associated with better survival.
- Only one-third of metastatic patients received second-line therapy, indicating treatment access challenges.

## Abstract

Introduction

Data on demography, stage distribution, treatment, and survival rates of renal cell carcinoma (RCC) in Colombia is not known. This study aims to describe a cohort of patients with RCC treated at the Clínica de Oncología Astorga, in Medellín, Colombia.

Methods

This retrospective study included all consecutive RCC patients treated at the institution between 2008 and 2023. Clinical, treatment, and survival data were collected from medical records. For metastatic and recurrent patients, risk was dichotomized as low-risk or non-low risk. The latter included those classified as intermediate/high risk in medical records, or cases with de novo metastatic disease or progression within 12 months of initial diagnosis. Event-free survival (EFS), progression-free survival (PFS), and overall survival (OS) were estimated using the Kaplan-Meier method and subgroup analysis was performed using metastatic status. Treatment patterns were compared with the log-rank test.

Results

Data of 208 patients were analyzed. The median age was 60.4 years (interquartile range (IQR) 51.9-69.8) and 114 subjects (54.8%) were men. Clear-cell histology was available for 167 patients (80.3%). Stages I, II, III, and IV disease was observed in 58 (27.9%), 34 (16.3%), 38 (18.3%), and 48 (23.1%) cases, respectively. Metastatic disease occurred in 107 (51.4%) patients (46 synchronous and 61 metachronous). Low-risk and non-low-risk metastatic disease was detected in 43 (40.2%) and 64 (59.8%) patients, respectively. Among non-metastatic patients, 126 (95.4%) patients underwent nephrectomy. First-line treatment included tyrosine kinase inhibitors (TKI) in 58 (70.7%), immunotherapy (IO) in 12 (14.6%), and other systemic therapies in 12 (14.6%) patients; 34 (31.8%) patients received a second-line regimen, most commonly from TKI to IO. Median OS for the entire cohort was 161.1 months. OS was significantly longer in non-metastatic versus metastatic patients at diagnosis (217.0 vs. 24.9 months; p<0.001). In metastatic disease, median OS differed by risk category (low-risk, 58.4 months vs. non-low-risk, 26.6 months; p=0.01) and by first-line treatment (TKI 42.2 months, IO 18.6 months, surgery 67.3 months; p=0.03).

Conclusion

In this institution-based real-world of RCC patients from Colombia, more than half presented with or subsequently developed metastatic disease; however, only one-third were able to access second-line therapy, highlighting substantial attrition in treatment sequencing. Non-metastatic status, low-risk metastatic classification, and first-line treatment with TKI were associated with superior survival outcomes.