Department of Urology, Ludwig Maximilian University, Marchioninistr. 15, 81377, Munich, Germany.
Int J Clin Oncol. 2019 Jun;24(6):694-697. doi: 10.1007/s10147-019-01398-x. Epub 2019 Feb 13.
Until recently, there was no approved adjuvant therapy (AT) for renal cell carcinoma (RCC) unless sunitinib was approved in the US. We evaluated clinical opinion and estimated use regarding different treatment options and patient selection of AT in RCC patients based on current scientific data and individual experience in Germany.
We conducted an anonymous survey during a national urology conference in 01/2017. Answers of 157 urologists treating RCC patients could be included. Questions were related to practice setting, treatment of RCC, follow-up strategy, physicians' personal opinion and individually different important parameters regarding S-TRAC and ASSURE-trial.
82% were office based. 67% were located in larger cities. 83% reported that nephron-sparing surgery (NSS) was performed in tumors with diameter < 4 cm. Follow-up was done mainly in concordance with guideline recommendations. 68% treated an average of 2.9 patients/year with systemic therapy. Therapy was predominantly advocated using sunitinib (94%). Urologists were informed about S-TRAC and ASSURE-trial. For 47%, reported hazard ratio is the most important parameter to understand trial results followed by overall survival (OS) in 46%, disease-free survival in 38%, and results of other trials in 34%. The most convincing parameter to decide on AT is OS (69%). 62% placed their confidence in ASSURE over STRAC-trial. 44% would use AT for 12 months. Nodal involvement was the most common denominator for use of AT. 82% favor sunitinib as AT.
A minority of urologists would use AT and are more confident in ASSURE-trial. Reluctance of prescribing AT mainly is based on lack of OS data and conflicting trial results.
直到最近，除非舒尼替尼在美国获得批准，否则肾细胞癌（RCC）没有被批准的辅助治疗（AT）。我们根据当前的科学数据和个人经验，评估了德国 RCC 患者不同治疗方案和患者选择 AT 的临床意见和估计使用情况。
我们在 2017 年 1 月的一次全国泌尿科会议期间进行了一项匿名调查。可以纳入 157 名治疗 RCC 患者的泌尿科医生的回答。问题涉及实践设置、RCC 治疗、随访策略、医生的个人意见以及 S-TRAC 和 ASSURE 试验中个别不同的重要参数。
82%的医生在办公室工作。67%的医生在较大的城市工作。83%的医生报告说，在直径<4cm 的肿瘤中进行了保肾手术（NSS）。随访主要是根据指南建议进行的。68%的医生平均每年治疗 2.9 名系统治疗患者。治疗主要提倡使用舒尼替尼（94%）。泌尿科医生了解 S-TRAC 和 ASSURE 试验。对于 47%的医生来说，报告的风险比是理解试验结果的最重要参数，其次是总生存率（OS）（46%）、无病生存率（DFS）（38%）和其他试验结果（34%）。决定 AT 的最有说服力的参数是 OS（69%）。62%的医生对 ASSURE 比 STRAC 试验更有信心。44%的医生将使用 AT 12 个月。淋巴结受累是使用 AT 的最常见共同标准。82%的医生赞成使用舒尼替尼作为 AT。
少数泌尿科医生会使用 AT，对 ASSURE 试验更有信心。不愿开 AT 主要是基于缺乏 OS 数据和相互矛盾的试验结果。
