Role of Cytoreductive Nephrectomy in Metastatic Clear Cell Renal cell Carcinoma in the Era of immunotherapy: An Analysis of the National Cancer Database

IF 2.3 3区 医学 Q3 ONCOLOGY Clinical genitourinary cancer Pub Date : 2024-08-21 DOI:10.1016/j.clgc.2024.102193
Maroun Bou Zerdan , Stephanie Niforatos , Swathi Arunachalam , Tamara Jamaspishvili , Roger Wong , Gennady Bratslavsky , Joseph Jacob , Jeffrey Ross , Oleg Shapiro , Hanan Goldberg , Alina Basnet
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引用次数: 0

Abstract

Background

The effectiveness of the clinical outcome of CN (Cytoreductive Nephrectomy) in cases of mccRCC (Metastatic Clear Cell Renal cell Carcinoma) is still uncertain despite two trials, SURTIME and CARMENA. These trials, conducted with Sunitinib as the standard treatment, did not provide evidence supporting the use of CN.

Methods

We queried the NCDB for stage IV mccRCC patients between the years of 2004 to 2020, who received (immunotherapy) IO with or without nephrectomy. Overall survival (OS) was calculated among three groups of IO alone, IO followed by CN (IOCN), CN followed by IO (CNIO). Cox models compared OS by treatment group after adjusting for sociodemographic, health, and facility variables.

Results

From 1,549,101 renal cancer cases, 7983 clear and nonclear cell renal cell carcinoma cases were identified. After adjusting for sociodemographic and health covariates, patients who received IO followed by CN or CN followed by IO had a respective 64% (adjusted Hazard Ratio [aHR] = 0.36, 95% CI = 0.30-0.43, P = .006] and 47% (aHR = 0.53, 95% CI = 0.49-0.56, P = .001) mortality risk reduction respectively compared to patients who received IO alone. Compared to White adults, individuals who identified as Black exhibited 17% higher risk mortality (aHR = 1.17, 95% CI = 1.06-1.30, P = .002). Patients who received CN prior to IO had a 59% associated mortality risk compared to patients who received IO followed by CN who had a lower risk, 35.7% (P < .001).

Conclusions

Patients receiving CN regardless of sequence with IO did better than IO alone in this national registry-based adjusted analysis for mccRCC. Presently available data indicates that the combination of CN and IO holds promise for enhancing clinical results in patients with mRCC.

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免疫疗法时代细胞清除性肾切除术在转移性透明细胞肾细胞癌中的作用:全国癌症数据库分析
尽管进行了 SURTIME 和 CARMENA 两项试验,但 CN(细胞修复性肾切除术)对转移性透明细胞肾细胞癌(mccRCC)的临床疗效仍不确定。这些试验以舒尼替尼作为标准治疗方法,并未提供支持使用 CN 的证据。我们在NCDB中查询了2004年至2020年期间接受(免疫疗法)IO并进行或未进行肾切除术的IV期mccRCC患者。计算了三组患者的总生存期(OS):单纯 IO 组、IO 后 CN 组(IOCN)、CN 后 IO 组(CNIO)。在调整了社会人口、健康和设备变量后,Cox模型比较了各治疗组的OS。从 1,549,101 例肾癌病例中,确定了 7983 例透明和非透明细胞肾细胞癌病例。在调整了社会人口和健康协变量后,接受 IO 后再接受 CN 或接受 CN 后再接受 IO 的患者与仅接受 IO 的患者相比,死亡率风险分别降低了 64%(调整后危险比 [aHR] = 0.36,95% CI = 0.30-0.43, = .006] 和 47%(aHR = 0.53,95% CI = 0.49-0.56, = .001)。与白人相比,黑人的死亡率风险高出17%(aHR = 1.17, 95% CI = 1.06-1.30, = .002)。在 IO 之前接受 CN 治疗的患者的相关死亡风险为 59%,而在 IO 之后接受 CN 治疗的患者的相关死亡风险较低,为 35.7% ( < .001)。在这项基于国家登记处的 mccRCC 调整分析中,无论 IO 顺序如何,接受 CN 治疗的患者均优于单独接受 IO 治疗的患者。现有数据表明,CN和IO联合治疗有望提高mRCC患者的临床疗效。
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来源期刊
Clinical genitourinary cancer
Clinical genitourinary cancer 医学-泌尿学与肾脏学
CiteScore
5.20
自引率
6.20%
发文量
201
审稿时长
54 days
期刊介绍: Clinical Genitourinary Cancer is a peer-reviewed journal that publishes original articles describing various aspects of clinical and translational research in genitourinary cancers. Clinical Genitourinary Cancer is devoted to articles on detection, diagnosis, prevention, and treatment of genitourinary cancers. The main emphasis is on recent scientific developments in all areas related to genitourinary malignancies. Specific areas of interest include clinical research and mechanistic approaches; drug sensitivity and resistance; gene and antisense therapy; pathology, markers, and prognostic indicators; chemoprevention strategies; multimodality therapy; and integration of various approaches.
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