A retrospective analysis of the clinico-epidemiological features and treatment outcomes of renal cell carcinoma at the Clinical Oncology Department at Ain Shams University in Egypt
TL;DR
High-risk pathological features identified in 33% of the localised cohort highlight an unmet need for adjuvant immunotherapy in resource-limited settings, and sunitinib provided meaningful and durable disease control despite restricted immunotherapy access in the metastatic setting.
Abstract
Background: Renal cell carcinoma (RCC) is a biologically heterogeneous malignancy with variable clinical behaviour and survival outcomes. Real-world data from low-and middle-income countries remain limited, particularly regarding stage-specific treatment patterns and survival outcomes. Methods: This retrospective cohort study included adult patients diagnosed with RCC and treated at the Clinical Oncology Department, Ain Shams University Hospitals, between January 2018 and December 2023. Patients were analysed as two pre-specified cohorts: (1) localised disease (Stage I–III) undergoing curative-intent surgery ( n = 45) and (2) metastatic disease (Stage IV) receiving systemic therapy ( n = 34). Survival outcomes were analysed using the Kaplan–Meier (KM) method and reported as medians with inter-quartile ranges (IQRs). Results: A total of 79 patients were included (50 male, 63.3%; median age 57 years, IQR 50–66). In the localised cohort ( n = 45), 43 underwent curative-intent surgery; disease recurrence occurred in 17 (39.5%). The 12-month disease-free survival (DFS) was 78.2%, and the 36-month DFS was 64.1%; median DFS was not reached within the observation period. In the metastatic cohort ( n = 34), sunitinib was the predominant first-line agent; the KM estimated median progression-free survival (PFS) on sunitinib was 16 months (IQR 6–36), with a 6-month PFS rate of 75.4% and a 12-month PFS rate of 58.0%. The KM estimated median overall survival (OS) for Stage IV patients was 43 months from diagnosis. Disease recurrence and progression were significantly associated with inferior OS ( p = 0.003 and p = 0.01, respectively). Conclusion: Surgical resection remains the cornerstone of curative management. In the metastatic setting, sunitinib provided meaningful and durable disease control (median PFS 16 months; KM median OS 43 months) despite restricted immunotherapy access. High-risk pathological features identified in 33% of the localised cohort highlight an unmet need for adjuvant immunotherapy in resource-limited settings.