Does size matter? A national analysis of patterns of adjuvant immunotherapy receipt and tumor size-dependent survival in pT3N0M0 clear cell renal cell carcinoma.

Authors

Ethan Wan, Aditya Sathe, Charles C Peyton, Cristina Magi-Galluzzi, James E Ferguson

Published in

Urologic oncology. Volume 44. Issue 9. Pages 272-281. Jul 02, 2026. Epub Jul 02, 2026.

Abstract

In November 2021, the US FDA approved pembrolizumab in the adjuvant setting for surgically resected clear cell renal cell carcinoma (ccRCC) at high-risk of recurrence, including small pT3a tumors. We hypothesized that this subgroup of small pT3a tumors have better outcomes and less benefit to adjuvant therapy than larger pT3 tumors. We herein investigate the patterns of adjuvant immunotherapy receipt and its effects on survival in pT3a ccRCC tumors stratified by tumor size.
Using the National Cancer Database (NCDB), we conducted a comprehensive analysis of survival outcomes and adjuvant immunotherapy receipt patterns among 25,089 pT3N0M0 ccRCC patients. Multivariable logistic regression modeling was used to identify independent predictors of adjuvant immunotherapy receipt in the adjuvant pembrolizumab approval era, and to evaluate overall survival outcomes by adjuvant immunotherapy receipt status. The Surveillance, Epidemiology, and End Results (SEER) database was used to evaluate cancer-specific survival (CSS) in pT3a tumors stratified by size.
Five-year CSS was 92.3% for pT3a tumors ≤4 cm and 74.4% for tumors >10 cm. Of the 8785 patients diagnosed with pT3N0M0 ccRCC in the NCDB after 1/1/2022, adjuvant immunotherapy was administered to 30.8% of patients. Younger age, Caucasian race, increased tumor size, higher tumor grade, positive surgical margins, and lower comorbidity burden were independent predictors of adjuvant immunotherapy receipt. Adjuvant immunotherapy was associated with improved overall survival in pT3a masses, with size-stratified analyses showing the largest effect size in masses 7 to 10 cm and >10 cm without statistical significance.
Adjuvant immunotherapy is being increasingly but incompletely adopted for pT3 ccRCC in recent practice. However, there is variation in which patients receive adjuvant therapy, with higher rates in younger and healthier patients with larger tumors. Small pT3a masses have excellent CSS outcomes, and adjuvant immunotherapy may have a differential effect based on tumor size.

PMID:
42391808
Bibliographic data and abstract were imported from PubMed on 03 Jul 2026.

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