Laparoscopic nephrectomy has lesser blood loss, quicker recovery and return to work, shorter hospital stay, lesser post operative pain and analgesia requirement associated with it compared to open nephrectomy along with having oncological equivalence to open nephrectomy for T1, T2 renal tumours and for level 1 renal vein invasion by tumour thrombus. It has assumed the status of the New Gold Standard.
Background: Racial differences in characteristics and prognosis of Asiatic and White patients receiving immunotherapy have not been well described. Methods: We studied 390 patients from the POPLAR and OAK studies who received atezolizumab with evaluable biomarker parameters retrieved from a subsequent bloodbased study. The differences of Asians versus Whites in baseline characteristics, outcomes and genetic mutations of atezolizumab therapy were assessed. Results: Asiatic and White patients differed in characteristics including smoking history, baseline sum of the longest diameters (BLSLD), EGFR mutation frequency, programmed death-ligand 1 (PD-L1) expression and blood-based tumor mutational burden (bTMB) level. Overall survival (OS) was longer in Asians compared with Whites before (median OS: 18.7 vs. 11.1 mo; P ¼ 0.005) and after (median OS: 20.9 vs. 12.6 mo; P ¼ 0.005) propensity score matching (PSM). Race was an independent prognostic factor for OS (Asian vs White: HR 0.647, 95% CI 0.447-0.936, P ¼ 0.021) in addition to performance status (PS), histology, BLSLD, and number of metastatic sites. The objective response rate (ORR) for Asians and Whites was 8.2% and 17.1%, respectively and disease control rate (DCR) was 51.2% and 47.7%, respectively. The blood-based mutational landscape differentiated between Asians and Whites. In the overall population, mutations of STK11, EGFR, KEAP1, POLE, GRM3, ATM and STAG2 were associated with treatment response while mutations of TP53, KEAP1, APC, RB1, CREBBP, EPHA5 and STAG2 were associated with OS. Comparing the frequency of efficacy-or prognosis-related mutations, Asians had more EGFR mutations and less TP53 and STK11 mutations than Whites. Conclusions: Asians and Whites differed in the clinicopathological features and mutational landscape which may explain the superior efficacy of atezolizumab in Asiatic patients with NSCLC. This study conveys implications for further studies on racial disparity in the treatment of immunotherapy.
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