Survival Outcomes Associated With Cytoreductive Nephrectomy in Patients With Metastatic Clear Cell Renal Cell Carcinoma

Chakiryan, Nicholas H.; Gore, L. Robert; Reich, Richard R.; Dunn, Rodney L.; Jiang, Da; Gillis, Kyle; Green, Elizabeth; Hajiran, Ali; Hugar, Lee A.; Zemp, Logan; Zhang, Jingsong; Jain, Rohit; Chahoud, Jad; Spiess, Philippe E.; Manley, Brandon; Sexton, Wade J.; Hollenbeck, Brent K.; Gilbert, Scott M.

doi:10.1001/jamanetworkopen.2022.12347

Cited by 19 publications

(11 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Recently, data from a cohort study from the National Cancer Database published by Chakiryan et al did not demonstrate a survival benefit for CN in patients with mRCC using instrumental variable analysis [ 46 ]. The authors claim that the indication for CN is primarily driven by factors that are not reflected in observational studies, leading to confounding results.…”

Section: Discussionmentioning

confidence: 99%

The Role of Cytoreductive Nephrectomy in Renal Cell Carcinoma with Sarcomatoid Histology: A Case Series and Review of the Literature

et al. 2022

View full text Add to dashboard Cite

Background: Renal cell carcinoma with sarcomatoid dedifferentiation represents a rare histological entity characterized by aggressive behavior, limited efficacy of tyrosine kinase inhibitors or mTOR inhibitors, and poor outcome. The immune checkpoint inhibitor therapy regimen combining ipilimumab with nivolumab represents a new standard of care for this patient population due to a hitherto unprecedented response rate and overall survival. On the other hand, the role of cytoreductive nephrectomy in metastatic renal cell carcinoma, in particular, with sarcomatoid histology, remains controversial. Patient and Methods: In the present case series, we report six patients with locally advanced or synchronous metastatic sarcomatoid renal cell carcinoma and intermediate or poor International Metastatic RCC Database Consortium (IMDC) risk score, five of whom were successfully subjected to cytoreductive nephrectomy. Results: All six patients received the combination regimen of ipilimumab with nivolumab. Five of these patients underwent upfront cytoreductive nephrectomy followed by systemic treatment without any significant delay, with a durable treatment outcome. Notably, two patients with poor prognostic features achieved a long-term major partial response to therapy. We also performed a review of the literature on optimal treatment strategies for patients with sarcomatoid renal cell carcinoma. Conclusion: Herein, we highlight the feasibility of performing cytoreductive nephrectomy in patients with intermediate/poor prognosis metastatic renal cell carcinoma with sarcomatoid dedifferentiation followed by immunotherapy with ipilimumab and nivolumab. To enhance the chances of immunotherapy success, cytoreductive nephrectomy should also be considered for patients presenting with a disease with adverse prognostic parameters.

show abstract

Section: Discussionmentioning

confidence: 99%

The Role of Cytoreductive Nephrectomy in Renal Cell Carcinoma with Sarcomatoid Histology: A Case Series and Review of the Literature

et al. 2022

View full text Add to dashboard Cite

show abstract

“…At present, positive associations between cytoreductive resection of primary tumors and superior overall survival rates have been demonstrated in a variety of solid metastatic tumors, such as advanced-stage endometrial cancer, cohesive gastric cancer, and ovarian cancer (20)(21)(22). As for mccRCC, a significant survival benefit associated with CN and systemic therapy was found in a study by Chakiryan et (23)(24)(25).…”

Section: Discussionmentioning

confidence: 97%

“…Overall, 70% (n=550) of the patients were randomly divided into the training cohorts, while the remaining 30% (n=232) were assigned to the internal test cohort. The median follow-up was 25 (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31) months in the SEER database. A total of 144 patients were included in the external test (PUMCH) cohort, and the median follow-up for this cohort was 37 (24-52) months.…”

Section: Baseline Characteristicsmentioning

confidence: 99%

Machine learning to improve prognosis prediction of metastatic clear-cell renal cell carcinoma treated with cytoreductive nephrectomy and systemic therapy

Yang

Dong

et al. 2022

Bosn J of Basic Med Sci

View full text Add to dashboard Cite

Cytoreductive nephrectomy (CN) combined with systemic therapy is commonly used to treat metastatic clear-cell renal cell carcinoma (mccRCC). However, prognostic models for these patients are limited. In the present study, the clinical data of 782 mccRCC patients who received both CN and systemic therapy were obtained from the Surveillance, Epidemiology, and End Results (SEER) database (2010-2016), and patients were divided into training and internal test cohorts. A total of 144 patients who met the same criteria from our center (Peking Union Medical College Hospital) were placed in the external test cohort. The cancer-specific survival rate (CSS) at 1, 3, and 5 years was set as the research outcome. Then, four ML models, i.e., a gradient boosting machine (GBM), support vector machine (SVM), random forest (RF), and logistic regression (LR), were established. Fifteen potential independent features were included in this study. Model performance was evaluated using the area under the receiver operating characteristic curves (AUC), calibration plots, and decision curve analysis (DCA). Seven clinical features, namely pathological grade, T stage, N stage, number of metastatic sites, brain or liver metastases, and metastasectomy were selected for subsequent analysis via the recursive feature elimination (RFE) algorithm. In conclusion, the GBM model performed best at 1-, 3- and 5-year CSS prediction (0.836, 0.819 and 0.808, respectively in the internal test cohort and 0.819, 0.805 and 0.786, respectively in the external cohort). Furthermore, we divided the patients into three strata (high-, intermediate- and low-risk) via X-tile analysis and concluded that clinically individualized treatment can be aided by these practical prognostic models.

show abstract

“…The pendulum has swung back and forth, with evidence supporting it in the cytokine era [9,10] and mixed results now in the context of targeted therapy. Although the CARMENA trial [11] found that upfront cytoreductive nephrectomy in Memorial Sloan-Kettering Cancer Center (MSKCC) intermediate-to-poor risk patients who require systemic therapy did not confer survival benefit, evidence from recent retrospective propensity-matched studies using large national databases suggest otherwise [12 ▪ –14 ▪ ]. With regard to the timing of cytoreductive nephrectomy, while the SURTIME trial [15] found significant survival benefit conferred by delayed versus upfront cytoreductive nephrectomy, two recent database studies [13 ▪ ,14 ▪ ] found no difference in overall survival (OS).…”

Section: Kidney Cancermentioning

confidence: 99%

The role of surgery for loco-regional and advanced urological cancers

Chow

Tay

Yuen

et al. 2022

Current Opinion in Urology

View full text Add to dashboard Cite

Purpose of reviewThere is a general misconception that surgery is the antithesis of palliation. However, symptom mitigation, the basic tenet of palliative interventions, can be achieved by invasive procedures. Surgical care, thus, plays an important role in palliative oncology, alongside radiation and systemic therapy. There is global movement to improve palliation in oncology, and thus it is timely to evaluate the role of surgical interventions can play in this setting. Recent findingsMany of the surgical interventions done with palliative intent were first established as curative options. Most studies looked at interventions for local control of primary tumour including extirpative surgeries, while some studies studied pain relief for bone metastases. Results show that patients have an acceptable survival outcome and complication rate comparable to those done in the curative setting. However, not all studies report functional outcomes and symptom-relief consistently, highlighting an unmet need. SummaryMore studies are needed to further define the role of surgery in palliative care. Randomized controlled trials studying surgical intervention in the palliative setting will be challenging because of lack of equipoise, inherent bias in patient and disease characteristics in those who undergo surgery. Nonetheless, studies should endeavour to study symptom-free survival and PROMs as meaningful endpoints of interventions performed in a palliative setting rather than solely focus on hard oncological endpoints of survival.

show abstract

Survival Outcomes Associated With Cytoreductive Nephrectomy in Patients With Metastatic Clear Cell Renal Cell Carcinoma

Cited by 19 publications

References 37 publications

The Role of Cytoreductive Nephrectomy in Renal Cell Carcinoma with Sarcomatoid Histology: A Case Series and Review of the Literature

The Role of Cytoreductive Nephrectomy in Renal Cell Carcinoma with Sarcomatoid Histology: A Case Series and Review of the Literature

Machine learning to improve prognosis prediction of metastatic clear-cell renal cell carcinoma treated with cytoreductive nephrectomy and systemic therapy

The role of surgery for loco-regional and advanced urological cancers

Contact Info

Product

Resources

About