Maxine Sun1, Christian P Meyer2, Jose A Karam3, Guillermo de Velasco1, Steven L Chang4, Sumanta K Pal5, Quoc-Dien Trinh4, Toni K Choueiri6. 1. Department of Medical Oncology, Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA, USA. 2. Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Center for Surgery and Public Health, Division of Urologic Surgery, Brigham and Women's Hospital, Boston, MA, USA. 3. Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 4. Center for Surgery and Public Health, Division of Urologic Surgery, Brigham and Women's Hospital, Boston, MA, USA. 5. Department of Medical Oncology & Therapeutics Research, City of Hope, Duarte, CA, USA. 6. Department of Medical Oncology, Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA, USA. Electronic address: toni_choueiri@dfci.harvard.edu.
Abstract
INTRODUCTION: Metastasectomy (MSX) is considered a treatment option in patients with metastatic renal cell carcinoma (mRCC) at diagnosis, but its role in the targeted therapy era is unclear. We sought to describe the utilization trends of MSX and survival outcomes in a large US cohort. MATERIALS AND METHODS: Using the National Cancer Database, we identified patients undergoing MSX for mRCC at diagnosis between 2006 and 2013. Linear regression methods estimated utilization trends, and hierarchical models identified independent predictors of MSX after adjusting for hospital clustering. Kaplan-Meier survival estimates and Cox proportional hazard models were used to evaluate overall survival according to treatment after propensity-score matching. RESULTS: Of 6994 mRCC patients, 1976 underwent MSX (28.3%). Those treated at academic facilities were more likely to undergo a MSX (OR: 1.57, 95% CI 1.20-2.06, p = 0.001). In contrast, older patients (OR: 0.99, 95% CI: 0.98-1.00), black race (OR: 0.65, 95% CI: 0.51-0.82), higher pT stage (OR: 0.76, 95% CI: 0.65-0.89), and who received targeted therapy (OR: 0.72, 95% CI: 0.63-0.82, all p ≤ 0.008) were less likely to undergo MSX. Overall, MSX patients had an improved survival compared to non-MSX patients (HR: 0.83, 95% CI: 0.77-0.90, p < 0.001), as well as among patients treated with targeted therapy (HR: 0.77, 95% CI: 0.77-0.96, p = 0.008). CONCLUSIONS: Our findings indicate that MSX-treated patients may benefit from an improved overall survival compared to non-MSX treated patients. Good patient selection and a proper risk stratification strategy are still very important considerations.
INTRODUCTION: Metastasectomy (MSX) is considered a treatment option in patients with metastatic renal cell carcinoma (mRCC) at diagnosis, but its role in the targeted therapy era is unclear. We sought to describe the utilization trends of MSX and survival outcomes in a large US cohort. MATERIALS AND METHODS: Using the National Cancer Database, we identified patients undergoing MSX for mRCC at diagnosis between 2006 and 2013. Linear regression methods estimated utilization trends, and hierarchical models identified independent predictors of MSX after adjusting for hospital clustering. Kaplan-Meier survival estimates and Cox proportional hazard models were used to evaluate overall survival according to treatment after propensity-score matching. RESULTS: Of 6994 mRCC patients, 1976 underwent MSX (28.3%). Those treated at academic facilities were more likely to undergo a MSX (OR: 1.57, 95% CI 1.20-2.06, p = 0.001). In contrast, older patients (OR: 0.99, 95% CI: 0.98-1.00), black race (OR: 0.65, 95% CI: 0.51-0.82), higher pT stage (OR: 0.76, 95% CI: 0.65-0.89), and who received targeted therapy (OR: 0.72, 95% CI: 0.63-0.82, all p ≤ 0.008) were less likely to undergo MSX. Overall, MSXpatients had an improved survival compared to non-MSXpatients (HR: 0.83, 95% CI: 0.77-0.90, p < 0.001), as well as among patients treated with targeted therapy (HR: 0.77, 95% CI: 0.77-0.96, p = 0.008). CONCLUSIONS: Our findings indicate that MSX-treated patients may benefit from an improved overall survival compared to non-MSX treated patients. Good patient selection and a proper risk stratification strategy are still very important considerations.
Authors: Andrey Soares; Fernando Sabino Marques Monteiro; Fernando Cotait Maluf; Diogo Assed Bastos; Denis Leonardo Jardim; André Deeke Sasse; Adriano Gonçalves E Silva; André P Fay; Diogo Augusto Rodrigues da Rosa; Evanius Wierman; Fabio Kater; Fabio A Schutz; Fernando Nunes Galvão de Oliveira; Igor Alexandre Protzner Morbeck; José Augusto Rinck; Karine Martins da Trindade; Manuel Caitano Maia; Vinicius Carrera Souza; Deusdedit Cortez Vieira da Silva Neto; Felipe de Almeida E Paula; Fernando Korkes; Gustavo Franco Carvalhal; Lucas Nogueira; Roni de Carvalho Fernandes; Rodolfo Borges Dos Reis; Wagner Eduardo Matheus; Wilson Francisco Schreiner Busato; Walter Henriques da Costa; Stênio de Cássio Zequi Journal: J Cancer Res Clin Oncol Date: 2020-05-14 Impact factor: 4.553