INTRODUCTION AND OBJECTIVE: The treatment landscape for early-stage renal cell carcinoma (RCC) following nephrectomy is rapidly evolving, especially with the approval of pembrolizumab adjuvant therapy in the United States. Exploratory survey questions aimed to quantify qualitative descriptors of the level of risk of recurrence and to examine physicians’ perceptions of risk and its determinants.
METHODS: The survey questions were included in a survey completed by physicians experienced with treating nonmetastatic RCC in the United States. Physicians were asked to (1) assign each of four categories of the risk of post nephrectomy disease recurrence (low, intermediate-low [int-low], intermediate-high [int-high], and high) to selected risk ranges; (2) categorize the risk of recurrence for three patient vignettes; and (3) assign an expected time until disease recurrence for two additional vignettes. Descriptive statistics were used.
RESULTS: 250 physicians (64% oncologists, 36% urologists) completed the survey. The median risk levels assigned by oncologists were <20% for low, 21%-50% for int-low, 51%-80% for int-high, and 51-80% for high risk. Urologists’ median risk levels were identical to those of oncologists in the sample, except for the int-high level, which urologists assigned 21%-50%. On average, physicians perceived an individual with pT3, Fuhrman Grade 3, N0, M0 tumor and ECOG Performance status (PS)=1 as int-low risk. Int-high risk was the median perceived risk level assessed for the following two vignettes: pT2, N0, M0, Fuhrman grade 4 tumor with sarcomatoid feature and ECOG PS 0; and pT3, N1, M0, Fuhrman grade 3 tumor and ECOG PS 1. More than one-third of physicians expected a patient with pT3 tumor to remain disease free for 2-3 years post nephrectomy (n=95; 38%) if N0 M0, and 1-2 years (n=92; 36.8%) if N1 M0.
CONCLUSIONS: Physicians’ perception of risk of recurrence post nephrectomy is critical when evaluating patient eligibility for and choosing to recommend adjuvant therapy. This exploratory analysis provides insights into risk perceptions among oncologists and urologists.
