S L Richey1, S H Culp2, E Jonasch1, P G Corn1, L C Pagliaro1, P Tamboli3, K K Patel4, S F Matin2, C G Wood2, N M Tannir5. 1. Department of Genitourinary Medical Oncology. 2. Department of Urology. 3. Department of Pathology, The University of Texas MD Anderson Cancer Center. 4. Department of Internal Medicine, The University of Texas Health Science Center, Houston, USA. 5. Department of Genitourinary Medical Oncology. Electronic address: ntannir@mdanderson.org.
Abstract
BACKGROUND: Cytoreductive nephrectomy (CN) became a standard procedure in metastatic renal cell carcinoma (mRCC) in the immunotherapy era. Historically, median overall survival (OS) of patients treated with interferon alpha (IFN-α) without CN was 7.8 months. Median OS in patients treated with targeted therapy (TT) without CN is unknown. PATIENTS AND METHODS: We retrospectively reviewed records of patients with mRCC who received TT without CN. Kaplan-Meier methods and Cox regression analysis were used to estimate median OS and identify poor prognostic factors. RESULTS: One hundred and eighty-eight patients were identified. Most patients had intermediate-risk (54.8%) or poor-risk (44.1%) disease. Median OS for all patients was 10.4 months [95% confidence interval (CI) 8.1-12.5]. By multivariable analysis, elevated baseline lactate dehydrogenase and corrected calcium, performance status of two or more, retroperitoneal nodal metastasis, thrombocytosis, current smoking, two or more metastatic sites, and lymphopenia were independent risk factors for inferior OS. Patients with four or more factors had increased risk of death (hazard ratio 8.83, 95% CI 5.02-15.5, P < 0.001) and 5.5-month median OS. Nineteen patients (10.0%) survived for 2+ years. CONCLUSIONS: These data highlight the improved OS of patients with mRCC treated with TT without CN, compared with historical IFN-α treatment, and may guide the design of trials investigating the role of CN in the TT era.
BACKGROUND: Cytoreductive nephrectomy (CN) became a standard procedure in metastatic renal cell carcinoma (mRCC) in the immunotherapy era. Historically, median overall survival (OS) of patients treated with interferon alpha (IFN-α) without CN was 7.8 months. Median OS in patients treated with targeted therapy (TT) without CN is unknown. PATIENTS AND METHODS: We retrospectively reviewed records of patients with mRCC who received TT without CN. Kaplan-Meier methods and Cox regression analysis were used to estimate median OS and identify poor prognostic factors. RESULTS: One hundred and eighty-eight patients were identified. Most patients had intermediate-risk (54.8%) or poor-risk (44.1%) disease. Median OS for all patients was 10.4 months [95% confidence interval (CI) 8.1-12.5]. By multivariable analysis, elevated baseline lactate dehydrogenase and corrected calcium, performance status of two or more, retroperitoneal nodal metastasis, thrombocytosis, current smoking, two or more metastatic sites, and lymphopenia were independent risk factors for inferior OS. Patients with four or more factors had increased risk of death (hazard ratio 8.83, 95% CI 5.02-15.5, P < 0.001) and 5.5-month median OS. Nineteen patients (10.0%) survived for 2+ years. CONCLUSIONS: These data highlight the improved OS of patients with mRCC treated with TT without CN, compared with historical IFN-α treatment, and may guide the design of trials investigating the role of CN in the TT era.
Authors: Harun Fajkovic; Shahrokh F Shariat; Tobias Klatte; Mihai Dorin Vartolomei; Ilaria Lucca; Aurélie Mbeutcha; Morgan Rouprêt; Alberto Briganti; Pierre I Karakiewicz; Vitaly Margulis; Michael Rink; Mesut Remzi; Christian Seitz; Karim Bensalah; Romain Mathieu Journal: World J Urol Date: 2016-02-15 Impact factor: 4.226
Authors: Madhur Nayan; Robert J Hamilton; Antonio Finelli; Peter C Austin; Girish S Kulkarni; David N Juurlink Journal: Can Urol Assoc J Date: 2017-06 Impact factor: 1.862
Authors: Javier Puente Vázquez; T Alonso Gordoa; J Moreno; L Poma; E Diaz Rubio; A Gomez; J Blazquez; J L Gonzalez Larriba Journal: Curr Treat Options Oncol Date: 2015-03
Authors: Che-kai Tsao; Alexander C Small; Max Kates; Erin L Moshier; Juan P Wisnivesky; Benjamin A Gartrell; Guru Sonpavde; James H Godbold; Michael A Palese; Simon J Hall; William K Oh; Matthew D Galsky Journal: World J Urol Date: 2012-12-08 Impact factor: 4.226