Clinical outcome of advanced and metastatic renal cell carcinoma treated with targeted therapy: is there a difference between young and old patients?

Abstract

BackgroundTo assess whether the clinical outcome of advanced and metastatic renal cell carcinoma (mRCC) treated with targeted therapy differs between young and old patients.Patients and methodsA total of 327 patients with advanced renal cell carcinoma and mRCC who received targeted therapy in two Chinese clinical centers were analyzed retrospectively. The patients were stratified into three groups: young (aged <45 years), middle-aged (aged 45–64 years), and old (aged ≥65 years). Overall survival (OS) and progression-free survival (PFS) curves were drawn using the Kaplan–Meier method, and Cox’s proportional hazard regression model was used to compare OS and PFS within age groups.ResultsThere were no significant differences among young, middle-aged, and old groups in terms of OS (P=0.087), whereas PFS in the old group was significantly better than in the young and middle-aged groups (P=0.043). Both OS and PFS in the younger groups (aged <65 years) were significantly worse than in the old group (age ≥65 years; median OS, 28.1 vs 28.7 months [P=0.029]; median PFS, 11.4 vs 14 months [P=0.015]). No difference in OS or PFS was found between the young and middle-aged groups. After adjusting for sex, body mass index, smoking status, hypertension, diabetes mellitus, Eastern Cooperative Oncology Group score, history of cytokines, and Fuhrman grade, old age was an independent favorable prognostic factor for OS and PFS compared with younger age (<65 years) (OS, hazard ratio, 0.552 [95% confidence interval, 0.329–0.828; P=0.006]; PFS, hazard ratio, 0.584 [95% confidence interval, 0.401–0.850; P=0.005]).ConclusionYounger patients with advanced renal cell carcinoma and mRCC receiving targeted therapy have a poorer prognosis compared with old patients. These results remain to be examined in prospective cohorts.

Prognostic analysis of Chinese patients with metastasis renal cell cancer receiving sorafenib: results from a multicenter long-term follow-up retrospective study

“…The results of our study were consistent with reported data from a small sampling of Chinese patients, which were little different from other Asian non-Chinese data. 9 , 18 In a Japanese study, they found that the median PFS was 7.4 months, the median OS was 25.3 months, and these results were also longer than that in the TARGET study. 19 Some results from another Japanese study showed that the median PFS was 9.0 months and sorafenib was effective in Japanese patients with advanced renal cell cancer in general clinical practice.…”

Clinical and Pathological Characteristics of Metastatic Renal Cell Carcinoma Patients Needing a Second-Line Therapy: A Systematic Review

“…Currently, uncertainties exist about the prognostic effect of age on RCC. Some authors have pointed out that older age is correlated with a higher stage and pathological grade, suggesting an adverse association with prognosis [50]. In their study, Zhang et al found that younger patients with mRCC receiving targeted therapy had a poorer prognosis compared with older patients [50].…”

“…Some authors have pointed out that older age is correlated with a higher stage and pathological grade, suggesting an adverse association with prognosis [50]. In their study, Zhang et al found that younger patients with mRCC receiving targeted therapy had a poorer prognosis compared with older patients [50]. Interestingly, the mean age of patients receiving axitinib, cabozantinib, nivolumab, and the combination of everolimus plus levatinib was < 65 years.…”

Proposal for a Two-Tier Re-classification of Stage IV/M1 domain of Renal Cell Carcinoma into M1 (“Oligometastatic”) and M2 (“Polymetastatic”) subdomains: Analysis of the Registry for Metastatic Renal Cell Carcinoma (REMARCC)

“…Stage IV/metastatic renal cell carcinoma (mRCC) has been historically associated with a poor prognosis. Nonetheless, outcomes in metastatic disease are not uniform and are influenced by both patient and disease factors (4,5). Existing risk stratification systems including Memorial Sloan Kettering Cancer Center (MSKCC)/Motzer criteria and International Metastatic RCC Database Consortium (IMDC)/Heng criteria staging have sought to stratify metastatic heterogeneity by incorporating clinical and laboratory data into prognostic groupings (6)(7)(8).…”