Assessment of survival of patients with metastatic clear cell renal cell carcinoma after radical cytoreductive nephrectomy versus no surgery: a SEER analysis

Xiao, Weizhong; Zhu, Yao; Dai, Bo; Zhang, Hai Liang; Ye, Ding Wei

doi:10.1590/s1677-5538.ibju.2015.02.15

Cited by 17 publications

(16 citation statements)

References 24 publications

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“…Other reports relying on population-based cohorts have also suggested improved OS in CN patients without providing actual information on the use of TT. [20][21][22] Therefore, the purported survival benefit of CN compared with non-CN patients in those reports merely assumes that patients received TT. In addition, those reports did not contain information on comorbidities, performance status, and other clinical variables, which may render comparative effectiveness of the two groups substantially unfair, because patients with poor health are unlikely to be considered for CN.…”

Section: Incremental Benefit Analysismentioning

confidence: 99%

Survival Analyses of Patients With Metastatic Renal Cancer Treated With Targeted Therapy With or Without Cytoreductive Nephrectomy: A National Cancer Data Base Study

Hanna

Sun

Meyer

et al. 2016

JCO

199

126

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Purpose The role of cytoreductive nephrectomy (CN) in metastatic renal cell carcinoma (mRCC) has become unclear since the introduction of targeted therapies (TT). We sought to evaluate contemporary utilization rates of CN and to examine the survival benefit of CN compared with non-CN patients treated with TT. Methods We used the National Cancer Data Base to identify patients with clinical mRCC treated with TT between 2006 and 2013. The intervention of interest was CN. Multivariable logistic regression predicting receipt of CN was performed. Overall survival (OS) was examined using Cox regression models and incremental survival analyses were performed. Sensitivity analyses using propensity scores were conducted. Results Of 15,390 patients treated with TT, 5,374 (35%) underwent CN between 2006 and 2013. Patients who were younger, privately insured, treated at an academic center, and had lower tumor stage and cN0 disease were more likely to undergo CN. The median OS of CN versus non-CN patients was 17.1 (95% CI, 16.3 to 18.0 months) versus 7.7 months (95% CI, 7.4 to 7.9 months; P < .001). In sensitivity analyses using propensity scores adjustment in addition to other available covariates, CN patients had a lower risk of any death (hazard ratio, 0.45; 95% CI, 0.40 to 0.50; P < .001). The survival benefit of CN was +0.7 and +3.6 months in patients who survived ≤ 6 and ≤ 24 months, respectively, versus no CN. Conclusion CN is performed in three of 10 patients with mRCC who are receiving TT. Several patient and sociodemographic characteristics were associated with receipt of CN. When feasible, CN may offer an OS benefit when combined with TT.

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Section: Incremental Benefit Analysismentioning

confidence: 99%

Survival Analyses of Patients With Metastatic Renal Cancer Treated With Targeted Therapy With or Without Cytoreductive Nephrectomy: A National Cancer Data Base Study

Hanna

Sun

Meyer

et al. 2016

JCO

199

126

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“…The most common pathological type (85%) of RCC is clear cell carcinoma [ 1 , 2 ]. It is important to accurately predict the survival of RCC patients; however, few efficient predictive tools are available [ 3 – 5 ], particularly for patients with metastatic RCC [ 6 ] (which remains incurable). Traditionally, immunochemotherapy has been used to treat nonmetastatic RCC, but the response rate was rarely more than 15%.…”

Section: Introductionmentioning

confidence: 99%

A Nomogram Predicting the Prognosis of Renal Cell Carcinoma Patients with Lung Metastases

Sheng

et al. 2021

BioMed Research International

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Background. The optimal tool for predicting the survival of renal cell carcinoma (RCC) patients with lung metastases remains controversial. Methods. We selected patients diagnosed with RCC and lung metastases, from 2010 to 2015, from the Surveillance, Epidemiology, and End Results (SEER) database. After the selection of inclusion criteria and exclusion criterion, the rest of the patients were incorporated into model analysis. Least absolute shrinkage and selection operator (LASSO) regression was used to select the most important features for construction of a nomogram predicting cancer-specific survival. A calibration plot and the concordance index ( C -index) were used to estimate nomogram efficacy in a validation cohort. The association between important factors selected by LASSO regression, and prognosis was assessed by the Kaplan-Meier (KM) survival curve. The receiver operating characteristic (ROC) curves were drawn to compare sensitivity and specificity between the nomogram we built and the TNM stage-based model. Results. A total of 1,369 patients met the inclusion criteria, but not the exclusion criteria. The LASSO regression model reduced 15 features to seven potential predictors of survival, including tumor grade, the extent of surgery, N and T status, histological profile, and brain and bone metastasis status. Such features had good discrimination in the KM survival curves. The nomogram showed excellent discriminatory power ( C -index, 0.71; 95% confidence interval: 0.70 to 0.72) and good calibration in terms of both 1- and 2-year cancer-specific survival. The nomogram showed great discriminatory power ( C -index 0.68) and adequate calibration when applied to the validation cohort. The areas under the curve (AUCs) of nomogram were 0.767 and 0.780, respectively, and the AUCs of TNM stage were 0.617 and 0.618 at 1 and 2 years, respectively. Conclusions. Our nomogram might play a major role in predicting the cancer-specific survival of RCC patients with lung metastases.

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“…After the match based upon propensity scores, the 1-, 2-and 3-year cancer-specific survival rate estimates were 45.1, 27.9 and 21.7% for the no surgery group versus 70.6, 52.2 and 41.7% for the surgery group, respectively (HR 0.42, 95% CI 0.35-0.52, long rank p < 0.001). The authors noted that the effect of performing CRN was related to a 2.5-fold increase in cancer-specific survival rate (p < 0.001) [27].…”

Section: Discussionmentioning

confidence: 99%

Cytoreductive Surgery in the Management of Renal Tumours: Rationale, Current Evidence and Future Perspectives

Khochikar

2016

Indian J Surg Oncol

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Renal cell carcinoma accounts for 3% of adult solid malignant tumours. Approximately 25% of the patients present with metastatic disease at presentation. In the era of immunotherapy (interferon alpha-2b and interleukin-2), studies showed significant survival benefit with cytoreductive nephrectomy (CRN) followed by interferon alpha-2b than interferon alpha 2-b alone. Introduction of targeted therapies (vascular endothelial growth factor receptor-tyrosine kinase inhibitors, mammalian target of rapamycin inhibitors) in 2005 generated a great interest in the management of metastatic renal cell carcinoma (mRCC) as these drugs exhibited tumour shrinkage in the primary tumour as well as in the metastatic site/s. Though there is no level 1 evidence, many studies have shown the usefulness of cytoreductive nephrectomy along with targeted therapy as against to targeted therapy alone. This review is aimed at the rationale behind the cytoreductive nephrectomy in mRCC, the current evidence and what is in store for the future. A detailed search on the management of mRCC was carried out on MEDLINE, Embase, CANCERLIT and Cochrane Library databases using the key words Bcytoreductive nephrectomy^, Bimmunotherapy^and Btargeted therapy^since 1980 till 2015. Original articles, review articles, monograms, book chapters on metastatic renal cancer and textbooks on urologic oncology, oncology and urology were reviewed. Various international guidelines on this issue were also studied. An identical search was performed using the American Society of Clinical Oncology Abstract database. Trials in the progress or recently completed that were relevant to this paper were identified through clinicaltrials.gov. The latest information for new articles ahead of publication was last accessed in November 2015. CRN has remained an integral part to the management of metastatic renal cell carcinoma mainly for the patients with good performance status, life expectancy of more than 12 months and in the absence of adverse prognostic factors. It had shown measurable survival benefit in the era of immunotherapy (CRN + immunotherapy vs. immunotherapy alone). In the era of targeted therapy, many studies have shown significant survival benefit with CRN + targeted therapy. However, there is no clear level 1 evidence to support this. The ongoing trials (CARMENA and European Organisation for Research and Treatment of Cancer SURTIME) would perhaps guide us in the way in which we should manage mRCC disease in the future. Maybe we may find some answers on the issues of the effectiveness of targeted therapy, the timing of CRN and sequencing these treatment arms once the results of these ongoing and future trials are through.

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Assessment of survival of patients with metastatic clear cell renal cell carcinoma after radical cytoreductive nephrectomy versus no surgery: a SEER analysis

Cited by 17 publications

References 24 publications

Survival Analyses of Patients With Metastatic Renal Cancer Treated With Targeted Therapy With or Without Cytoreductive Nephrectomy: A National Cancer Data Base Study

Survival Analyses of Patients With Metastatic Renal Cancer Treated With Targeted Therapy With or Without Cytoreductive Nephrectomy: A National Cancer Data Base Study

A Nomogram Predicting the Prognosis of Renal Cell Carcinoma Patients with Lung Metastases

Cytoreductive Surgery in the Management of Renal Tumours: Rationale, Current Evidence and Future Perspectives

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