Division of Hematology and Medical Oncology, The Tisch Cancer Institute, Mount Sinai School of Medicine, New York, NY 10029, USA.
Clin Genitourin Cancer. 2012 Sep;10(3):159-63. doi: 10.1016/j.clgc.2012.03.008. Epub 2012 May 30.
Two randomized trials published in 2001 established CyNx for patients with metastatic renal carcinoma (mRCC) as a treatment standard in the cytokine era. However, first-line systemic therapy for mRCC changed in 2005 with FDA approval of VEGFR TKIs. We evaluated the patterns of use of CyNx from 2000 to 2008.
The National Cancer Database was queried for patients diagnosed with mRCC. Patients who underwent CyNx were identified and were further categorized by pre-VEGFR versus VEGFR TKI era, race, insurance status, and hospital. For these subcategories, prevalence ratios (PRs) were generated using the proportion of patients with mRCC undergoing CyNx versus those not undergoing CyNx.
Of the 47,417 patients (pts) identified with mRCC, the prevalence of cytoreductive nephrectomy increased 3% each year from 2000 to 2005 (P < .0001), then decreased 3% each year from 2005 to 2008 (P = .0048), with a significant difference between the eras (0.97 vs. 1.025; P < .0001). Black and Hispanic pts were less likely than Caucasian pts to undergo CyNx. Pts with Medicaid, Medicare, and no insurance were less likely than pts with private insurance to undergo CyNx. Pts diagnosed at community hospitals were significantly less likely than pts at teaching hospitals to undergo CyNx.
The use of CyNx has declined in the VEGFR-TKI era. In addition, racial and socioeconomic disparities exist in the use of CyNx. The results of pending randomized trials evaluating the role of CyNx in the VEGFR-TKI era are awaited to optimize use of this modality and address potential disparities.
两项于 2001 年发表的随机试验确立了 CyNx 作为细胞因子时代转移性肾细胞癌（mRCC）患者的治疗标准。然而，随着美国食品药品监督管理局（FDA）批准血管内皮生长因子受体酪氨酸激酶抑制剂（VEGFR-TKIs），mRCC 的一线系统治疗于 2005 年发生改变。我们评估了 2000 年至 2008 年 CyNx 的使用模式。
国家癌症数据库（National Cancer Database）中检索了诊断为 mRCC 的患者。确定接受 CyNx 的患者，并进一步按 VEGFR-TKI 时代前、种族、保险状况和医院进行分类。对于这些亚组，使用 mRCC 患者中接受 CyNx 治疗与未接受 CyNx 治疗的患者比例生成患病率比值（PR）。
在 47417 例（pts）mRCC 患者中，细胞减灭性肾切除术的患病率从 2000 年到 2005 年每年增加 3%（P<0.0001），然后从 2005 年到 2008 年每年减少 3%（P=0.0048），两个时代之间有显著差异（0.97 与 1.025；P<0.0001）。黑人患者和西班牙裔患者接受 CyNx 的可能性低于白人患者。有医疗补助、医疗保险和无保险的患者接受 CyNx 的可能性低于有私人保险的患者。在社区医院诊断的患者接受 CyNx 的可能性显著低于教学医院的患者。
在 VEGFR-TKI 时代，CyNx 的使用减少了。此外，CyNx 的使用存在种族和社会经济差异。正在进行的评估 CyNx 在 VEGFR-TKI 时代作用的随机试验的结果有待观察，以优化这种治疗方式并解决潜在的差异。
