Michele Marchioni1, Marco Bandini2, Felix Preisser3, Zhe Tian4, Anil Kapoor5, Luca Cindolo6, Giulia Primiceri7, Francesco Berardinelli6, Alberto Briganti8, Shahrokh F Shariat9, Luigi Schips10, Pierre I Karakiewicz11. 1. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada; Department of Urology, SS Annunziata Hospital, "G.D'Annunzio" University of Chieti, Chieti, Italy. Electronic address: mic.marchioni@gmail.com. 2. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada; Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy. 3. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada; Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany. 4. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada. 5. Division of Urology, McMaster University, Hamilton, ON, Canada. 6. Department of Urology, ASL Abruzzo 2, Chieti, Italy. 7. Department of Urology, SS Annunziata Hospital, "G.D'Annunzio" University of Chieti, Chieti, Italy. 8. Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy. 9. Department of Urology, Medical University of Vienna, Vienna, Austria. 10. Department of Urology, SS Annunziata Hospital, "G.D'Annunzio" University of Chieti, Chieti, Italy; Department of Urology, ASL Abruzzo 2, Chieti, Italy. 11. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada; Department of Urology, University of Montreal Health Centre, Montreal, QC, Canada.
Abstract
BACKGROUND: The benefit of cytoreductive nephrectomy (CNT) for cancer-specific mortality (CSM)-free survival is unclear in contemporary metastatic non-clear cell renal cell carcinoma (non-ccmRCC) patients. OBJECTIVE: To assess the role of CNT in non-ccmRCC patients. DESIGN, SETTING, AND PARTICIPANTS: Within Surveillance, Epidemiology, and End Results registry (2001-2014), we identified patients with non-ccmRCC. INTERVENTION: CNT versus no CNT in non-ccmRCC patients. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Multivariable logistic regression, cumulative incidence, competing-risks regression models, incremental survival benefit (ISB), conditional survival, and landmark analyses were performed. Sensitivity analyses focused on histological subtypes and most contemporary patients (2010-2014). RESULTS AND LIMITATIONS: Of 851 patients with non-ccmRCC, 67.6% underwent CNT. In multivariable logistic regression, year of diagnosis in contemporary (p<0.001) and intermediate (p=0.008) tertiles, as well as age ≥75 yr (p<0.001) yielded lower CNT rates. Cumulative incidence showed 2-yr CSM of 52.6% versus 77.7%, respectively, after CNT versus no CNT. CSM after CNT versus no CNT was invariably lower in all histologic subtypes and in contemporary patients. Multivariable competing-risks regression models predicting CSM favored CNT (hazard ratio [HR]: 0.38, confidence interval: 0.30-0.47, p<0.001) in all patients and in all subgroups defined by histologic subtypes (HR: 0.14-0.43, all p≤0.02), as well as in contemporary patients (HR: 0.32, p<0.001). The ISB analyses yielded statistically significant and clinically meaningful CSM-free survival benefit of +3 mo after CNT versus no CNT in individuals with observed CSM-free survival ≤24 mo. The 2-yr CSM-free survival increased from baseline of 46.1% versus 19.4% (Δ=26.7%, p<0.001) to 70.3% versus 54.4% (Δ=15.9%, p=0.005) after CNT versus no CNT, in patients that survived 12 mo, respectively. Landmark analyses rejected bias favoring CNT. Data were retrospective. CONCLUSIONS: CSM is lower after CNT for non-ccmRCC in all histologic subtypes and in contemporary patients except for unproven ISB in collecting duct patients. This observation should encourage greater CNT consideration in non-ccmRCC. PATIENT SUMMARY: Cytoreductive nephrectomy appears to improve survival in metastatic non-clear cell renal cell carcinoma, but it is used infrequently.
BACKGROUND: The benefit of cytoreductive nephrectomy (CNT) for cancer-specific mortality (CSM)-free survival is unclear in contemporary metastatic non-clear cell renal cell carcinoma (non-ccmRCC) patients. OBJECTIVE: To assess the role of CNT in non-ccmRCC patients. DESIGN, SETTING, AND PARTICIPANTS: Within Surveillance, Epidemiology, and End Results registry (2001-2014), we identified patients with non-ccmRCC. INTERVENTION: CNT versus no CNT in non-ccmRCC patients. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Multivariable logistic regression, cumulative incidence, competing-risks regression models, incremental survival benefit (ISB), conditional survival, and landmark analyses were performed. Sensitivity analyses focused on histological subtypes and most contemporary patients (2010-2014). RESULTS AND LIMITATIONS: Of 851 patients with non-ccmRCC, 67.6% underwent CNT. In multivariable logistic regression, year of diagnosis in contemporary (p<0.001) and intermediate (p=0.008) tertiles, as well as age ≥75 yr (p<0.001) yielded lower CNT rates. Cumulative incidence showed 2-yr CSM of 52.6% versus 77.7%, respectively, after CNT versus no CNT. CSM after CNT versus no CNT was invariably lower in all histologic subtypes and in contemporary patients. Multivariable competing-risks regression models predicting CSM favored CNT (hazard ratio [HR]: 0.38, confidence interval: 0.30-0.47, p<0.001) in all patients and in all subgroups defined by histologic subtypes (HR: 0.14-0.43, all p≤0.02), as well as in contemporary patients (HR: 0.32, p<0.001). The ISB analyses yielded statistically significant and clinically meaningful CSM-free survival benefit of +3 mo after CNT versus no CNT in individuals with observed CSM-free survival ≤24 mo. The 2-yr CSM-free survival increased from baseline of 46.1% versus 19.4% (Δ=26.7%, p<0.001) to 70.3% versus 54.4% (Δ=15.9%, p=0.005) after CNT versus no CNT, in patients that survived 12 mo, respectively. Landmark analyses rejected bias favoring CNT. Data were retrospective. CONCLUSIONS: CSM is lower after CNT for non-ccmRCC in all histologic subtypes and in contemporary patients except for unproven ISB in collecting duct patients. This observation should encourage greater CNT consideration in non-ccmRCC. PATIENT SUMMARY: Cytoreductive nephrectomy appears to improve survival in metastatic non-clear cell renal cell carcinoma, but it is used infrequently.
Authors: Ross J Mason; Lori Wood; Anil Kapoor; Naveen Basappa; George Bjarnason; Stephen A Boorjian; Rodney H Breau; Ilias Cagiannos; Michael A S Jewett; Pierre I Karakiewicz; Wassim Kassouf; Christian Kollmannsberger; Aly-Khan A Lalani; Jean-Baptiste Lattouf; Luke T Lavallée; Stephen Pautler; Nicholas Power; Patrick Richard; Alan So; Simon Tanguay; Ricardo A Rendon Journal: Can Urol Assoc J Date: 2019-06 Impact factor: 1.862
Authors: Andrew W Silagy; Jessica Flynn; Roy Mano; Kyle A Blum; Julian Marcon; Renzo G DiNatale; Alejandro Sanchez; Maria I Carlo; Robert J Motzer; Jonathan A Coleman; Paul Russo; Irina Ostrovnaya; Yingbei B Chen; Ari A Hakimi Journal: Urol Oncol Date: 2019-09-12 Impact factor: 3.498
Authors: Jeffrey Graham; J Connor Wells; Frede Donskov; Jae Lyun Lee; Anna Fraccon; Felice Pasini; Camillo Porta; I Alex Bowman; Georg A Bjarnason; D Scott Ernst; Sun Young Rha; Benoit Beuselinck; Aaron Hansen; Scott A North; Christian K Kollmannsberger; Lori A Wood; Ulka N Vaishampayan; Sumanta K Pal; Toni K Choueiri; Daniel Y C Heng Journal: Eur Urol Oncol Date: 2019-04-05
Authors: Benedikt Hoeh; Rocco Simone Flammia; Lukas Hohenhorst; Gabriele Sorce; Andrea Panunzio; Stefano Tappero; Zhe Tian; Fred Saad; Michele Gallucci; Alberto Briganti; Carlo Terrone; Shahrokh F Shariat; Markus Graefen; Derya Tilki; Alessandro Antonelli; Marina Kosiba; Philipp Mandel; Luis A Kluth; Andreas Becker; Felix K H Chun; Pierre I Karakiewicz Journal: Eur Urol Open Sci Date: 2022-08-30