Damla Gunenc , Wadih Issa , Thomas Gerald , Qinhan Zhou , Song Zhang , I. Chidera Ibezue , Raj Bhanvadia , Isamu Tachibana , James Brugarolas , Hans Hammers , Qian Qin , Payal Kapur , Solomon Woldu , Kris Gaston , Yair Lotan , Jeffrey Cadeddu , Andrew Z. Wang , Vitaly Margulis , Tian Zhang
{"title":"转移性肾细胞癌（mRCC）患者接受以免疫疗法为基础的疗法和延期细胞切除肾切除术（CN）后的病理反应和预后。","authors":"Damla Gunenc , Wadih Issa , Thomas Gerald , Qinhan Zhou , Song Zhang , I. Chidera Ibezue , Raj Bhanvadia , Isamu Tachibana , James Brugarolas , Hans Hammers , Qian Qin , Payal Kapur , Solomon Woldu , Kris Gaston , Yair Lotan , Jeffrey Cadeddu , Andrew Z. Wang , Vitaly Margulis , Tian Zhang","doi":"10.1016/j.clgc.2024.102177","DOIUrl":null,"url":null,"abstract":"<div><p>In this study we evaluated outcomes of patients with metastatic renal cell carcinoma who received immunotherapy before surgery. We found that receiving immunotherapy combinations before surgery can offer patients benefits in reducing tumor size and improving disease control.</p></div><div><h3>Background</h3><p>Immunotherapy (IO) has improved outcomes for patients with metastatic renal cell carcinoma (mRCC). However, the timing of surgical intervention for cytoreductive nephrectomy (CN) is still controversial for this group of patients.</p></div><div><h3>Patients and Methods</h3><p>We identified patients with mRCC receiving IO-based therapies and undergoing CN. Patients were divided into 2 cohorts: those who underwent upfront CN and those who underwent deferred CN. Pathologic and radiographic features along with clinical outcomes were systematically collected. Comparisons were performed using Chi-square test, paired t-Test or Mann-Whitney-U test. Progression Free survival (PFS) and Overall Survival (OS) were estimated using the Kaplan-Meier method.</p></div><div><h3>Results</h3><p>Fifty-one patients with mRCC were included, with a median follow-up of 21 months. 38 (74.5%) patients received IO-based therapies prior to CN, while 13 (25.5%) patients underwent up-front CN. IO-based therapies reduced median tumor size from pretreatment 10 cm to 8.6 cm post-treatment when given prior to CN. IO-TKI had a trend toward higher tumor shrinkage (-2.3 vs -1.2 cm). Pathologic T downstaging occurred in 42% (n=16) of patients, 11% (n=4) of whom had pT0 disease. Thrombus downstaging occurred in 13% (n=6) of patients, all with either partial response (PR) or complete response (CR) in metastases. PFS (HR=0.7, 95% CI 0.29-1.98, p=0.58) and OS (HR 0.4, 95% CI 0.13-1.57, p=0.21) were not statistically significant between 2 cohorts.</p></div><div><h3>Conclusions</h3><p>IO-based therapies, particularly IO-TKIs, resulted in pathologic necrosis and reductions in tumor size prior to deferred CN. PFS and OS were similar for patients who received either upfront IO-based therapy or after CN.</p></div>","PeriodicalId":2,"journal":{"name":"ACS Applied Bio Materials","volume":null,"pages":null},"PeriodicalIF":4.6000,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Pathological Response and Outcomes in Patients With Metastatic Renal Cell Carcinoma (mRCC) Receiving Immunotherapy-Based Therapies and Undergoing Deferred Cytoreductive Nephrectomy (CN)\",\"authors\":\"Damla Gunenc , Wadih Issa , Thomas Gerald , Qinhan Zhou , Song Zhang , I. Chidera Ibezue , Raj Bhanvadia , Isamu Tachibana , James Brugarolas , Hans Hammers , Qian Qin , Payal Kapur , Solomon Woldu , Kris Gaston , Yair Lotan , Jeffrey Cadeddu , Andrew Z. Wang , Vitaly Margulis , Tian Zhang\",\"doi\":\"10.1016/j.clgc.2024.102177\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><p>In this study we evaluated outcomes of patients with metastatic renal cell carcinoma who received immunotherapy before surgery. We found that receiving immunotherapy combinations before surgery can offer patients benefits in reducing tumor size and improving disease control.</p></div><div><h3>Background</h3><p>Immunotherapy (IO) has improved outcomes for patients with metastatic renal cell carcinoma (mRCC). However, the timing of surgical intervention for cytoreductive nephrectomy (CN) is still controversial for this group of patients.</p></div><div><h3>Patients and Methods</h3><p>We identified patients with mRCC receiving IO-based therapies and undergoing CN. Patients were divided into 2 cohorts: those who underwent upfront CN and those who underwent deferred CN. Pathologic and radiographic features along with clinical outcomes were systematically collected. Comparisons were performed using Chi-square test, paired t-Test or Mann-Whitney-U test. Progression Free survival (PFS) and Overall Survival (OS) were estimated using the Kaplan-Meier method.</p></div><div><h3>Results</h3><p>Fifty-one patients with mRCC were included, with a median follow-up of 21 months. 38 (74.5%) patients received IO-based therapies prior to CN, while 13 (25.5%) patients underwent up-front CN. IO-based therapies reduced median tumor size from pretreatment 10 cm to 8.6 cm post-treatment when given prior to CN. IO-TKI had a trend toward higher tumor shrinkage (-2.3 vs -1.2 cm). Pathologic T downstaging occurred in 42% (n=16) of patients, 11% (n=4) of whom had pT0 disease. Thrombus downstaging occurred in 13% (n=6) of patients, all with either partial response (PR) or complete response (CR) in metastases. PFS (HR=0.7, 95% CI 0.29-1.98, p=0.58) and OS (HR 0.4, 95% CI 0.13-1.57, p=0.21) were not statistically significant between 2 cohorts.</p></div><div><h3>Conclusions</h3><p>IO-based therapies, particularly IO-TKIs, resulted in pathologic necrosis and reductions in tumor size prior to deferred CN. PFS and OS were similar for patients who received either upfront IO-based therapy or after CN.</p></div>\",\"PeriodicalId\":2,\"journal\":{\"name\":\"ACS Applied Bio Materials\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":4.6000,\"publicationDate\":\"2024-07-23\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"ACS Applied Bio Materials\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1558767324001484\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"MATERIALS SCIENCE, BIOMATERIALS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"ACS Applied Bio Materials","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1558767324001484","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"MATERIALS SCIENCE, BIOMATERIALS","Score":null,"Total":0}
引用次数: 0
摘要
在这项研究中，我们评估了在手术前接受免疫疗法的转移性肾细胞癌患者的疗效。我们发现，在手术前接受免疫疗法联合治疗可使患者在缩小肿瘤体积和改善疾病控制方面获益。免疫疗法（IO）改善了转移性肾细胞癌（mRCC）患者的治疗效果。然而，对于这部分患者来说，细胞切除肾切除术（CN）的手术干预时机仍存在争议。我们确定了接受 IO 型疗法并接受 CN 的 mRCC 患者。患者被分为两组：接受前期肾切除术的患者和接受延期肾切除术的患者。系统地收集了病理学和放射学特征以及临床结果。比较采用卡方检验、配对 t 检验或 Mann-Whitney-U 检验。无进展生存期（PFS）和总生存期（OS）采用 Kaplan-Meier 法进行估计。共纳入51例mRCC患者，中位随访时间为21个月。38例（74.5%）患者在接受CN治疗前接受了基于IO的疗法，13例（25.5%）患者接受了前期CN治疗。在接受 CN 治疗前，IO 类疗法可将肿瘤的中位尺寸从治疗前的 10 厘米缩小到治疗后的 8.6 厘米。IO-TKI的肿瘤缩小率呈上升趋势（-2.3 vs -1.2 cm）。42%（16 人）的患者出现病理 T 下分期，其中 11%（4 人）为 pT0 病变。13%（n=6）的患者出现血栓减期，所有患者的转移灶均为部分反应（PR）或完全反应（CR）。两组患者的 PFS（HR=0.7，95% CI 0.29-1.98，p=0.58）和 OS（HR 0.4，95% CI 0.13-1.57，p=0.21）差异无统计学意义。以IO为基础的疗法，尤其是IO-TKIs，可在推迟CN治疗前导致肿瘤病理坏死和缩小。接受前期 IO 治疗或 CN 治疗后的患者的 PFS 和 OS 相似。在这项研究中，我们评估了手术前接受免疫疗法的患者的疗效。我们发现，在手术前接受免疫疗法联合治疗可使患者在缩小肿瘤体积和改善疾病控制方面获益。
Pathological Response and Outcomes in Patients With Metastatic Renal Cell Carcinoma (mRCC) Receiving Immunotherapy-Based Therapies and Undergoing Deferred Cytoreductive Nephrectomy (CN)
In this study we evaluated outcomes of patients with metastatic renal cell carcinoma who received immunotherapy before surgery. We found that receiving immunotherapy combinations before surgery can offer patients benefits in reducing tumor size and improving disease control.
Background
Immunotherapy (IO) has improved outcomes for patients with metastatic renal cell carcinoma (mRCC). However, the timing of surgical intervention for cytoreductive nephrectomy (CN) is still controversial for this group of patients.
Patients and Methods
We identified patients with mRCC receiving IO-based therapies and undergoing CN. Patients were divided into 2 cohorts: those who underwent upfront CN and those who underwent deferred CN. Pathologic and radiographic features along with clinical outcomes were systematically collected. Comparisons were performed using Chi-square test, paired t-Test or Mann-Whitney-U test. Progression Free survival (PFS) and Overall Survival (OS) were estimated using the Kaplan-Meier method.
Results
Fifty-one patients with mRCC were included, with a median follow-up of 21 months. 38 (74.5%) patients received IO-based therapies prior to CN, while 13 (25.5%) patients underwent up-front CN. IO-based therapies reduced median tumor size from pretreatment 10 cm to 8.6 cm post-treatment when given prior to CN. IO-TKI had a trend toward higher tumor shrinkage (-2.3 vs -1.2 cm). Pathologic T downstaging occurred in 42% (n=16) of patients, 11% (n=4) of whom had pT0 disease. Thrombus downstaging occurred in 13% (n=6) of patients, all with either partial response (PR) or complete response (CR) in metastases. PFS (HR=0.7, 95% CI 0.29-1.98, p=0.58) and OS (HR 0.4, 95% CI 0.13-1.57, p=0.21) were not statistically significant between 2 cohorts.
Conclusions
IO-based therapies, particularly IO-TKIs, resulted in pathologic necrosis and reductions in tumor size prior to deferred CN. PFS and OS were similar for patients who received either upfront IO-based therapy or after CN.
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