Mathieu Romain, Pignot Géraldine, Ingles Alexandre, Crepel Maxime, Bigot Pierre, Bernhard Jean-Christophe, Joly Florence, Guy Laurent, Ravaud Alain, Azzouzi Abdel Rahmene, Gravis Gwenaelle, Chevreau Christine, Zini Laurent, Lang Hervé, Pfister Christian, Lechevallier Eric, Fais Pierre-Olivier, Berger Julien, Vayleux Bertrand, Roupret Morgan, Audenet François, Descazeaud Aurelien, Rigaud Jerome, Machiels Jean-Pascal, Staehler Michael, Salomon Laurent, Ferriere Jean-Marie, Kleinclauss Francois, Bensalah Karim, Patard Jean-Jacques
Department of Urology, Pontchaillou Hospital, Rennes University, Rennes, France.
Department of Urology, Bicetre Hospital, Paris XI University, Le Kremlin Bicêtre, France.
Urol Oncol. 2015 Aug;33(8):339.e9-15. doi: 10.1016/j.urolonc.2015.05.014. Epub 2015 Jun 16.
The role of cytoreductive nephrectomy (CN) in the treatment of patients harboring metastatic renal cell carcinoma (mRCC) has become controversial since the emergence of effective targeted therapies. The aim of our study was to compare the overall survival (OS) between CN and non-CN groups of patients presenting with mRCC in the era of targeted drugs and to assess these outcomes among the different Memorial Sloan-Kettering Cancer Center (MSKCC) and The Eastern Cooperative Oncology Group (ECOG) performance status subgroups.
A total of 351 patients with mRCC at diagnosis recruited from 18 tertiary care centers who had been treated with systemic treatment were included in this retrospective study. OS was assessed by the Kaplan-Meier method according to the completion of a CN. The population was subsequently stratified according to MSKCC and ECOG prognostic groups.
Median OS in the entire cohort was 37.1 months. Median OS was significantly improved for patients who underwent CN (16.4 vs. 38.1 months, P<0.001). However, subgroup analysis demonstrated that OS improvement after CN was only significant among the patients with an ECOG score of 0 to 1 (16.7 vs. 43.3 months, P = 0.03) and the group of patients with good and intermediate MSKCC score (16.8 vs. 42.4 months, P = 0.02). On the contrary, this benefit was not significant for the patients with an ECOG score of 2 to 3 (8.0 vs. 12.6 months, P = 0.8) or the group with poor MSKCC score (5.2 vs. 5.2, P = 0.9).
CN improves OS in patients with mRCC. However, this effect does not seem to be significant for the patients in ECOG performance status groups of 2 to 3 or poor MSKCC prognostic group.
自从有效靶向治疗出现以来，减瘤性肾切除术（CN）在转移性肾细胞癌（mRCC）患者治疗中的作用已变得具有争议性。我们研究的目的是比较在靶向药物时代mRCC患者中CN组和非CN组的总生存期（OS），并在不同的纪念斯隆凯特琳癌症中心（MSKCC）和东部肿瘤协作组（ECOG）体能状态亚组中评估这些结果。
本回顾性研究纳入了从18个三级医疗中心招募的共351例诊断为mRCC且接受过全身治疗的患者。根据是否完成CN，采用Kaplan-Meier法评估OS。随后根据MSKCC和ECOG预后分组对人群进行分层。
整个队列的中位OS为37.1个月。接受CN的患者中位OS显著改善（16.4对38.1个月，P<0.001）。然而，亚组分析表明，CN术后OS改善仅在ECOG评分为0至1的患者中显著（16.7对43.3个月，P = 0.03）以及MSKCC评分良好和中等的患者组中显著（16.8对42.4个月，P = 0.02）。相反，对于ECOG评分为2至3的患者（8.0对12.6个月，P = 0.8）或MSKCC评分差的组（5.2对5.2，P = 0.9），这种益处并不显著。
CN可改善mRCC患者的OS。然而，对于ECOG体能状态分组为2至3的患者或MSKCC预后差的组，这种效果似乎并不显著。
