Cytoreductive Nephrectomy in Metastatic Papillary Renal Cell Carcinoma: Results from the International Metastatic Renal Cell Carcinoma Database Consortium
There is evidence that cytoreductive nephrectomy (CN) may be beneficial in metastatic renal cell carcinoma (mRCC). This has been studied predominantly in clear-cell RCC, with more limited data on the role of CN in patients with papillary histology. To determine the benefit of CN in synchronous metas...
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| Veröffentlicht in: | European urology oncology 2019-11, Vol.2 (6), p.643-648 |
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| creator | Graham, Jeffrey Wells, J. Connor Donskov, Frede Lee, Jae Lyun Fraccon, Anna Pasini, Felice Porta, Camillo Bowman, I. Alex Bjarnason, Georg A. Ernst, D. Scott Rha, Sun Young Beuselinck, Benoit Hansen, Aaron North, Scott A. Kollmannsberger, Christian K. Wood, Lori A. Vaishampayan, Ulka N. Pal, Sumanta K. Choueiri, Toni K. Heng, Daniel Y.C. |
| description | There is evidence that cytoreductive nephrectomy (CN) may be beneficial in metastatic renal cell carcinoma (mRCC). This has been studied predominantly in clear-cell RCC, with more limited data on the role of CN in patients with papillary histology.
To determine the benefit of CN in synchronous metastatic papillary RCC.
Using the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) database, a retrospective analysis was performed for patients with papillary mRCC treated with or without CN.
Median overall survival (OS) and progression-free survival (PFS) were determined for both patient groups. Cox regression analysis was performed to control for imbalances in individual IMDC risk factors.
In total, 647 patients with papillary mRCC were identified, of whom 353 had synchronous metastatic disease. Of these, 109 patients were treated with CN and 244 were not. The median follow-up was 57.1mo (95% confidence interval [CI] 32.9–77.8) and the OS from the start of first-line targeted therapy for the entire cohort was 13.2mo (95% CI 12.0–16.1). Median OS for patients with CN was 16.3mo, compared to 8.6mo (p |
| doi_str_mv | 10.1016/j.euo.2019.03.007 |
| format | Article |
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To determine the benefit of CN in synchronous metastatic papillary RCC.
Using the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) database, a retrospective analysis was performed for patients with papillary mRCC treated with or without CN.
Median overall survival (OS) and progression-free survival (PFS) were determined for both patient groups. Cox regression analysis was performed to control for imbalances in individual IMDC risk factors.
In total, 647 patients with papillary mRCC were identified, of whom 353 had synchronous metastatic disease. Of these, 109 patients were treated with CN and 244 were not. The median follow-up was 57.1mo (95% confidence interval [CI] 32.9–77.8) and the OS from the start of first-line targeted therapy for the entire cohort was 13.2mo (95% CI 12.0–16.1). Median OS for patients with CN was 16.3mo, compared to 8.6mo (p<0.0001) in the no-CN group. When adjusted for individual IMDC risk factors, the hazard ratio (HR) of death for CN was 0.62 (95% CI 0.45–0.85; p=0.0031). Limitations include the retrospective nature of the analysis.
The use of CN in patients with mRCC and papillary histology appears to be associated with better survival compared to no CN after adjustment for risk criteria. Selection of appropriate candidates for CN is crucial. A clinical trial in this rare population may not be possible.
In a population of patients with advanced papillary kidney cancer, we found that surgical removal of the primary kidney tumor was associated with better overall survival.
Cytoreductive nephrectomy (CN) is associated with better survival in metastatic papillary renal cell carcinoma, even when controlling for known prognostic imbalances between CN and no-CN groups. As in the clear-cell renal cell carcinoma population, selecting which patients to perform CN on will be critical. A prospective clinical trial in this rare subgroup may not be possible.</description><identifier>ISSN: 2588-9311</identifier><identifier>EISSN: 2588-9311</identifier><identifier>DOI: 10.1016/j.euo.2019.03.007</identifier><identifier>PMID: 31411994</identifier><language>eng</language><publisher>Netherlands: Elsevier B.V</publisher><subject>Carcinoma, Renal Cell - mortality ; Carcinoma, Renal Cell - pathology ; Carcinoma, Renal Cell - surgery ; Cytoreductive nephrectomy ; Databases, Factual ; Humans ; Kidney cancer ; Metastatic renal cell carcinoma ; Neoplasm Metastasis ; Nephrectomy - methods ; Papillary ; Progression-Free Survival ; Retrospective Studies ; Survival Analysis</subject><ispartof>European urology oncology, 2019-11, Vol.2 (6), p.643-648</ispartof><rights>2019 European Association of Urology</rights><rights>Copyright © 2019 European Association of Urology. Published by Elsevier B.V. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c517t-54102a568a2cd0edd16dfb3eaf7c00a38a3b30b882c117874bee58d6873629a43</citedby><cites>FETCH-LOGICAL-c517t-54102a568a2cd0edd16dfb3eaf7c00a38a3b30b882c117874bee58d6873629a43</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31411994$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Graham, Jeffrey</creatorcontrib><creatorcontrib>Wells, J. Connor</creatorcontrib><creatorcontrib>Donskov, Frede</creatorcontrib><creatorcontrib>Lee, Jae Lyun</creatorcontrib><creatorcontrib>Fraccon, Anna</creatorcontrib><creatorcontrib>Pasini, Felice</creatorcontrib><creatorcontrib>Porta, Camillo</creatorcontrib><creatorcontrib>Bowman, I. Alex</creatorcontrib><creatorcontrib>Bjarnason, Georg A.</creatorcontrib><creatorcontrib>Ernst, D. Scott</creatorcontrib><creatorcontrib>Rha, Sun Young</creatorcontrib><creatorcontrib>Beuselinck, Benoit</creatorcontrib><creatorcontrib>Hansen, Aaron</creatorcontrib><creatorcontrib>North, Scott A.</creatorcontrib><creatorcontrib>Kollmannsberger, Christian K.</creatorcontrib><creatorcontrib>Wood, Lori A.</creatorcontrib><creatorcontrib>Vaishampayan, Ulka N.</creatorcontrib><creatorcontrib>Pal, Sumanta K.</creatorcontrib><creatorcontrib>Choueiri, Toni K.</creatorcontrib><creatorcontrib>Heng, Daniel Y.C.</creatorcontrib><title>Cytoreductive Nephrectomy in Metastatic Papillary Renal Cell Carcinoma: Results from the International Metastatic Renal Cell Carcinoma Database Consortium</title><title>European urology oncology</title><addtitle>Eur Urol Oncol</addtitle><description>There is evidence that cytoreductive nephrectomy (CN) may be beneficial in metastatic renal cell carcinoma (mRCC). This has been studied predominantly in clear-cell RCC, with more limited data on the role of CN in patients with papillary histology.
To determine the benefit of CN in synchronous metastatic papillary RCC.
Using the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) database, a retrospective analysis was performed for patients with papillary mRCC treated with or without CN.
Median overall survival (OS) and progression-free survival (PFS) were determined for both patient groups. Cox regression analysis was performed to control for imbalances in individual IMDC risk factors.
In total, 647 patients with papillary mRCC were identified, of whom 353 had synchronous metastatic disease. Of these, 109 patients were treated with CN and 244 were not. The median follow-up was 57.1mo (95% confidence interval [CI] 32.9–77.8) and the OS from the start of first-line targeted therapy for the entire cohort was 13.2mo (95% CI 12.0–16.1). Median OS for patients with CN was 16.3mo, compared to 8.6mo (p<0.0001) in the no-CN group. When adjusted for individual IMDC risk factors, the hazard ratio (HR) of death for CN was 0.62 (95% CI 0.45–0.85; p=0.0031). Limitations include the retrospective nature of the analysis.
The use of CN in patients with mRCC and papillary histology appears to be associated with better survival compared to no CN after adjustment for risk criteria. Selection of appropriate candidates for CN is crucial. A clinical trial in this rare population may not be possible.
In a population of patients with advanced papillary kidney cancer, we found that surgical removal of the primary kidney tumor was associated with better overall survival.
Cytoreductive nephrectomy (CN) is associated with better survival in metastatic papillary renal cell carcinoma, even when controlling for known prognostic imbalances between CN and no-CN groups. As in the clear-cell renal cell carcinoma population, selecting which patients to perform CN on will be critical. A prospective clinical trial in this rare subgroup may not be possible.</description><subject>Carcinoma, Renal Cell - mortality</subject><subject>Carcinoma, Renal Cell - pathology</subject><subject>Carcinoma, Renal Cell - surgery</subject><subject>Cytoreductive nephrectomy</subject><subject>Databases, Factual</subject><subject>Humans</subject><subject>Kidney cancer</subject><subject>Metastatic renal cell carcinoma</subject><subject>Neoplasm Metastasis</subject><subject>Nephrectomy - methods</subject><subject>Papillary</subject><subject>Progression-Free Survival</subject><subject>Retrospective Studies</subject><subject>Survival Analysis</subject><issn>2588-9311</issn><issn>2588-9311</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kduKFDEURQtRnGGcD_BF8uhLl7nUJaUgSI2XgfGC6HM4lZyy01QlbZJq6F_xa03TM0MPiASSQ7L3Tk5WUTxntGSUNa82JS6-5JR1JRUlpe2j4pzXUq46wdjjk_qsuIxxQynleTDKnxZnglWMdV11Xvzp98kHNItOdofkC27XAXXy855YRz5jgpggWU2-wdZOE4Q9-Y4OJtLjlCcI2jo_w-u8G5cpRTIGP5O0RnLtEgaXvf4gP0n6l59cQYIBIpLeu-hDssv8rHgywhTx8na9KH5-eP-j_7S6-frxun93s9I1a9OqrnJPUDcSuDYUjWGNGQeBMLaaUhASxCDoICXXjLWyrQbEWppGtqLhHVTionh7zN0uw4xGo0sBJrUNds7tKg9WPTxxdq1--Z1qpGy4kDng5W1A8L8XjEnNNurcHzj0S1Sct6KtK960WcqOUh18jAHH-2sYVQesaqMyVnXAqqhQGWv2vDh9373jDmIWvDkKMP_SzmJQUVt0Go09sFTG2__E_wXAgLc2</recordid><startdate>20191101</startdate><enddate>20191101</enddate><creator>Graham, Jeffrey</creator><creator>Wells, J. Connor</creator><creator>Donskov, Frede</creator><creator>Lee, Jae Lyun</creator><creator>Fraccon, Anna</creator><creator>Pasini, Felice</creator><creator>Porta, Camillo</creator><creator>Bowman, I. Alex</creator><creator>Bjarnason, Georg A.</creator><creator>Ernst, D. Scott</creator><creator>Rha, Sun Young</creator><creator>Beuselinck, Benoit</creator><creator>Hansen, Aaron</creator><creator>North, Scott A.</creator><creator>Kollmannsberger, Christian K.</creator><creator>Wood, Lori A.</creator><creator>Vaishampayan, Ulka N.</creator><creator>Pal, Sumanta K.</creator><creator>Choueiri, Toni K.</creator><creator>Heng, Daniel Y.C.</creator><general>Elsevier B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20191101</creationdate><title>Cytoreductive Nephrectomy in Metastatic Papillary Renal Cell Carcinoma: Results from the International Metastatic Renal Cell Carcinoma Database Consortium</title><author>Graham, Jeffrey ; Wells, J. Connor ; Donskov, Frede ; Lee, Jae Lyun ; Fraccon, Anna ; Pasini, Felice ; Porta, Camillo ; Bowman, I. Alex ; Bjarnason, Georg A. ; Ernst, D. 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Connor</au><au>Donskov, Frede</au><au>Lee, Jae Lyun</au><au>Fraccon, Anna</au><au>Pasini, Felice</au><au>Porta, Camillo</au><au>Bowman, I. Alex</au><au>Bjarnason, Georg A.</au><au>Ernst, D. Scott</au><au>Rha, Sun Young</au><au>Beuselinck, Benoit</au><au>Hansen, Aaron</au><au>North, Scott A.</au><au>Kollmannsberger, Christian K.</au><au>Wood, Lori A.</au><au>Vaishampayan, Ulka N.</au><au>Pal, Sumanta K.</au><au>Choueiri, Toni K.</au><au>Heng, Daniel Y.C.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cytoreductive Nephrectomy in Metastatic Papillary Renal Cell Carcinoma: Results from the International Metastatic Renal Cell Carcinoma Database Consortium</atitle><jtitle>European urology oncology</jtitle><addtitle>Eur Urol Oncol</addtitle><date>2019-11-01</date><risdate>2019</risdate><volume>2</volume><issue>6</issue><spage>643</spage><epage>648</epage><pages>643-648</pages><issn>2588-9311</issn><eissn>2588-9311</eissn><abstract>There is evidence that cytoreductive nephrectomy (CN) may be beneficial in metastatic renal cell carcinoma (mRCC). This has been studied predominantly in clear-cell RCC, with more limited data on the role of CN in patients with papillary histology.
To determine the benefit of CN in synchronous metastatic papillary RCC.
Using the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) database, a retrospective analysis was performed for patients with papillary mRCC treated with or without CN.
Median overall survival (OS) and progression-free survival (PFS) were determined for both patient groups. Cox regression analysis was performed to control for imbalances in individual IMDC risk factors.
In total, 647 patients with papillary mRCC were identified, of whom 353 had synchronous metastatic disease. Of these, 109 patients were treated with CN and 244 were not. The median follow-up was 57.1mo (95% confidence interval [CI] 32.9–77.8) and the OS from the start of first-line targeted therapy for the entire cohort was 13.2mo (95% CI 12.0–16.1). Median OS for patients with CN was 16.3mo, compared to 8.6mo (p<0.0001) in the no-CN group. When adjusted for individual IMDC risk factors, the hazard ratio (HR) of death for CN was 0.62 (95% CI 0.45–0.85; p=0.0031). Limitations include the retrospective nature of the analysis.
The use of CN in patients with mRCC and papillary histology appears to be associated with better survival compared to no CN after adjustment for risk criteria. Selection of appropriate candidates for CN is crucial. A clinical trial in this rare population may not be possible.
In a population of patients with advanced papillary kidney cancer, we found that surgical removal of the primary kidney tumor was associated with better overall survival.
Cytoreductive nephrectomy (CN) is associated with better survival in metastatic papillary renal cell carcinoma, even when controlling for known prognostic imbalances between CN and no-CN groups. As in the clear-cell renal cell carcinoma population, selecting which patients to perform CN on will be critical. A prospective clinical trial in this rare subgroup may not be possible.</abstract><cop>Netherlands</cop><pub>Elsevier B.V</pub><pmid>31411994</pmid><doi>10.1016/j.euo.2019.03.007</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Carcinoma, Renal Cell - mortality Carcinoma, Renal Cell - pathology Carcinoma, Renal Cell - surgery Cytoreductive nephrectomy Databases, Factual Humans Kidney cancer Metastatic renal cell carcinoma Neoplasm Metastasis Nephrectomy - methods Papillary Progression-Free Survival Retrospective Studies Survival Analysis |
| title | Cytoreductive Nephrectomy in Metastatic Papillary Renal Cell Carcinoma: Results from the International Metastatic Renal Cell Carcinoma Database Consortium |
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