Fares Aline F, Araujo Daniel V, Calsavara Vinicius, Saito Augusto Obuti, Formiga Maria Nirvana, Dettino Aldo A, Zequi Stenio, da Costa Walter H, Cunha Isabela W
Department of Medical Oncology, AC Camargo Cancer Center, São Paulo 01525-001, Brazil.
Department of Medical Oncology, University Health Network, Toronto, ON M5G 1L7, Canada.
Ecancermedicalscience. 2019 Oct 14;13:967. doi: 10.3332/ecancer.2019.967. eCollection 2019.
We evaluated overall survival (OS) benefit of complete metastasectomy (CM) in metastatic renal cell carcinoma (mRCC) using a propensity score-matched (PSM) analysis to balance groups by age, gender and by the International Metastatic RCC Database Consortium prognostic model (IMDC).
We included patients (pts) treated at the AC Camargo Cancer Center between 2007 and 2016. Pairs were matched by age, gender and IMDC. Kaplan-Meier survival estimates and Cox proportional hazard models were used to evaluate OS on CM and no-CM group.
We found 116 pts with clear cell mRCC. After PSM, the number was reduced to 74 (37 CM, 37 no-CM). The median OS for CM and no-CM was 98.3 months and 40.5 months, respectively (hazard ratio 0.24 95%CI 0.11-0.53 p < 0.001). The OS benefit of CM was confirmed on favourable and intermediate IMDC but was absent on poor IMDC. The CM group received less systemic therapy than the no-CM group. Ten pts in the CM group still have no evidence of disease (NED).
After matching for age, gender and IMDC, we found CM impacts on OS and also diminishes the need for systemic treatment. Survival benefit was confirmed for favourable/intermediate IMDC but not for the poor IMDC prognostic model. Further studies correlating IMDC and metastasectomy are needed to guide clinical decision-making.
我们使用倾向评分匹配（PSM）分析评估了转移性肾细胞癌（mRCC）中完全转移灶切除术（CM）对总生存期（OS）的益处，以通过年龄、性别和国际转移性肾细胞癌数据库联盟预后模型（IMDC）平衡各组。
我们纳入了2007年至2016年期间在AC卡马戈癌症中心接受治疗的患者（pts）。根据年龄、性别和IMDC进行配对。采用Kaplan-Meier生存估计和Cox比例风险模型评估CM组和非CM组的OS。
我们发现116例透明细胞mRCC患者。PSM后，数量减少至74例（37例CM，37例非CM）。CM组和非CM组的中位OS分别为98.3个月和40.5个月（风险比0.24，95%CI 0.11 - 0.53，p < 0.001）。CM对OS的益处在有利和中等风险的IMDC中得到证实，但在低风险的IMDC中未观察到。CM组接受的全身治疗比非CM组少。CM组中有10例患者仍无疾病证据（NED）。
在匹配年龄、性别和IMDC后，我们发现CM对OS有影响，并且减少了全身治疗的需求。对于有利/中等风险的IMDC，生存益处得到证实，但对于低风险的IMDC预后模型则未得到证实。需要进一步开展将IMDC与转移灶切除术相关联的研究以指导临床决策。
