Romain Mathieu1, Géraldine Pignot2, Alexandre Ingles3, Maxime Crepel1, Pierre Bigot4, Jean-Christophe Bernhard5, Florence Joly6, Laurent Guy7, Alain Ravaud5, Abdel Rahmene Azzouzi4, Gwenaelle Gravis8, Christine Chevreau9, Laurent Zini10, Hervé Lang11, Christian Pfister12, Eric Lechevallier13, Pierre-Olivier Fais13, Julien Berger14, Bertrand Vayleux15, Morgan Roupret16, François Audenet16, Aurelien Descazeaud14, Jerome Rigaud15, Jean-Pascal Machiels17, Michael Staehler18, Laurent Salomon19, Jean-Marie Ferriere5, Francois Kleinclauss20, Karim Bensalah1, Jean-Jacques Patard3. 1. Department of Urology, Pontchaillou Hospital, Rennes University, Rennes, France. 2. Department of Urology, Bicetre Hospital, Paris XI University, Le Kremlin Bicêtre, France. Electronic address: geraldine.pignot@bct.aphp.fr. 3. Department of Urology, Bicetre Hospital, Paris XI University, Le Kremlin Bicêtre, France. 4. Department of Urology, Angers University Hospital, Angers, France. 5. Departments of Urology and Oncology, Bordeaux University, Bordeaux, France. 6. Department of Oncology, Centre François Baclesse, Caen, France. 7. Departments of Urology, Clermont-Ferrand University, Clermont-Ferrand, France. 8. Department of Oncology, Institut Paoli-Calmettes, Marseille, France. 9. Department of Oncology, Institut Claudius Regaud, Toulouse University, Toulouse, France. 10. Department of Urology, Huriez Hospital, Lille Nord de France University, Lille, France. 11. Department of Urology, Strasbourg Hospital, University of Strasbourg, Strasbourg, France. 12. Department of Urology, Rouen University Hospital, Rouen, France. 13. Department of Urology, La Conception Hospital, Marseille University, Marseille, France. 14. Department of Urology, Dupuytren Hospital, Limoges University, Limoges, France. 15. Department of Urology, Hôtel Dieu Hospital, Nantes University, Nantes, France. 16. Department of Urology, Pitié Salpétrière Hospital, Paris VI University, Paris, France. 17. Department of Oncology, Cliniques Universitaires St-Luc, Louvain University, Brussels, Belgium. 18. Department of Urology, Ludwig-Maximilian-University of Munich, Munchen, Germany. 19. Department of Urology, Henri Mondor Hospital, Paris XII University, Créteil, France. 20. Department of Urology, Besancon University, Besancon, France.
Abstract
OBJECTIVES: The role of cytoreductive nephrectomy (CN) in the treatment of patients harboring metastatic renal cell carcinoma (mRCC) has become controversial since the emergence of effective targeted therapies. The aim of our study was to compare the overall survival (OS) between CN and non-CN groups of patients presenting with mRCC in the era of targeted drugs and to assess these outcomes among the different Memorial Sloan-Kettering Cancer Center (MSKCC) and The Eastern Cooperative Oncology Group (ECOG) performance status subgroups. METHODS AND MATERIALS: A total of 351 patients with mRCC at diagnosis recruited from 18 tertiary care centers who had been treated with systemic treatment were included in this retrospective study. OS was assessed by the Kaplan-Meier method according to the completion of a CN. The population was subsequently stratified according to MSKCC and ECOG prognostic groups. RESULTS: Median OS in the entire cohort was 37.1 months. Median OS was significantly improved for patients who underwent CN (16.4 vs. 38.1 months, P<0.001). However, subgroup analysis demonstrated that OS improvement after CN was only significant among the patients with an ECOG score of 0 to 1 (16.7 vs. 43.3 months, P = 0.03) and the group of patients with good and intermediate MSKCC score (16.8 vs. 42.4 months, P = 0.02). On the contrary, this benefit was not significant for the patients with an ECOG score of 2 to 3 (8.0 vs. 12.6 months, P = 0.8) or the group with poor MSKCC score (5.2 vs. 5.2, P = 0.9). CONCLUSIONS: CN improves OS in patients with mRCC. However, this effect does not seem to be significant for the patients in ECOG performance status groups of 2 to 3 or poor MSKCC prognostic group.
OBJECTIVES: The role of cytoreductive nephrectomy (CN) in the treatment of patients harboring metastatic renal cell carcinoma (mRCC) has become controversial since the emergence of effective targeted therapies. The aim of our study was to compare the overall survival (OS) between CN and non-CN groups of patients presenting with mRCC in the era of targeted drugs and to assess these outcomes among the different Memorial Sloan-Kettering Cancer Center (MSKCC) and The Eastern Cooperative Oncology Group (ECOG) performance status subgroups. METHODS AND MATERIALS: A total of 351 patients with mRCC at diagnosis recruited from 18 tertiary care centers who had been treated with systemic treatment were included in this retrospective study. OS was assessed by the Kaplan-Meier method according to the completion of a CN. The population was subsequently stratified according to MSKCC and ECOG prognostic groups. RESULTS: Median OS in the entire cohort was 37.1 months. Median OS was significantly improved for patients who underwent CN (16.4 vs. 38.1 months, P<0.001). However, subgroup analysis demonstrated that OS improvement after CN was only significant among the patients with an ECOG score of 0 to 1 (16.7 vs. 43.3 months, P = 0.03) and the group of patients with good and intermediate MSKCC score (16.8 vs. 42.4 months, P = 0.02). On the contrary, this benefit was not significant for the patients with an ECOG score of 2 to 3 (8.0 vs. 12.6 months, P = 0.8) or the group with poor MSKCC score (5.2 vs. 5.2, P = 0.9). CONCLUSIONS: CN improves OS in patients with mRCC. However, this effect does not seem to be significant for the patients in ECOG performance status groups of 2 to 3 or poor MSKCC prognostic group.
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