TY - JOUR
T1 - Cytoreductive Nephrectomy in Metastatic Papillary Renal Cell Carcinoma
T2 - Results from the International Metastatic Renal Cell Carcinoma Database Consortium
AU - Graham, Jeffrey
AU - Wells, J. Connor
AU - Donskov, Frede
AU - Lee, Jae Lyun
AU - Fraccon, Anna
AU - Pasini, Felice
AU - Porta, Camillo
AU - Bowman, I. Alex
AU - Bjarnason, Georg A.
AU - Ernst, D. Scott
AU - Rha, Sun Young
AU - Beuselinck, Benoit
AU - Hansen, Aaron
AU - North, Scott A.
AU - Kollmannsberger, Christian K.
AU - Wood, Lori A.
AU - Vaishampayan, Ulka N.
AU - Pal, Sumanta K.
AU - Choueiri, Toni K.
AU - Heng, Daniel Y.C.
N1 - Publisher Copyright:
Copyright © 2019 European Association of Urology. Published by Elsevier B.V. All rights reserved.
PY - 2019/11/1
Y1 - 2019/11/1
N2 - BACKGROUND: 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. OBJECTIVE: To determine the benefit of CN in synchronous metastatic papillary RCC. DESIGN, SETTING, AND PARTICIPANTS: 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. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: 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. RESULTS AND LIMITATIONS: 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. CONCLUSIONS: 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. PATIENT SUMMARY: 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.
AB - BACKGROUND: 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. OBJECTIVE: To determine the benefit of CN in synchronous metastatic papillary RCC. DESIGN, SETTING, AND PARTICIPANTS: 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. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: 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. RESULTS AND LIMITATIONS: 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. CONCLUSIONS: 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. PATIENT SUMMARY: 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.
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U2 - 10.1016/j.euo.2019.03.007
DO - 10.1016/j.euo.2019.03.007
M3 - Article
C2 - 31411994
AN - SCOPUS:85074964954
SN - 2588-9311
VL - 2
SP - 643
EP - 648
JO - European urology oncology
JF - European urology oncology
IS - 6
ER -
