既往肾切除术对接受免疫肿瘤治疗的转移性肾癌临床结局的影响：代表Meet-URO组（MeetUro-7b）开展的一项真实世界研究
Impact of Previous Nephrectomy on Clinical Outcome of Metastatic Renal Carcinoma Treated With Immune-Oncology: A Real-World Study on Behalf of Meet-URO Group (MeetUro-7b).
作者信息
Stellato Marco, Santini Daniele, Verzoni Elena, De Giorgi Ugo, Pantano Francesco, Casadei Chiara, Fornarini Giuseppe, Maruzzo Marco, Sbrana Andrea, Di Lorenzo Giuseppe, Soraru Mariella, Naglieri Emanuele, Buti Sebastiano, De Vivo Rocco, Napolitano Andrea, Vignani Francesca, Mucciarini Claudia, Grillone Francesco, Roviello Giandomenico, Di Napoli Marilena, Procopio Giuseppe
机构信息
Department of Medical Oncology, Campus Bio-Medico University of Rome, Rome, Italy.
Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
出版信息
Front Oncol. 2021 Jun 8;11:682449. doi: 10.3389/fonc.2021.682449. eCollection 2021.
BACKGROUND
Immune-Oncology (IO) improves Overall Survival (OS) in metastatic Renal Cell Carcinoma (mRCC). The prognostic impact of previous Cytoreductive Nephrectomy (CN) and radical nephrectomy (RN), with curative intent, in patients treated with IO is not well defined. The aim of our paper is to evaluate the impact of previous nephrectomy on outcome of mRCC patients treated with IO.
METHODS
287 eligible patients were retrospectively collected from 16 Italian referral centers adhering to the MeetUro association. Patients treated with IO as second and third line were included, whereas patients treated with IO as first line were excluded. Kaplan-Meier method and log-rank test were performed to compare Progression Free Survival (PFS) and OS between groups. In our analysis, both CN and RN were included. The association between nephrectomy and other variables was analyzed in univariate and multivariate setting using the Cox proportional hazard model.
RESULTS
246/287 (85.7%) patients had nephrectomy before IO treatment. Median PFS in patients who underwent nephrectomy (246/287) was 4.8 months (95%CI 3.9-5.7) vs 3.7 months (95%CI 1.9-5.5) in patients who did not it (HR log rank 0.78; 95%CI 0.53 to 1.15; = 0.186). Median OS in patients who had previous nephrectomy (246/287) was 20.9 months (95%CI 17.6-24.1) 13 months (95%CI 7.7-18.2) in patients who did not it (HR log rank 0.504; 95%CI 0.337 to 0.755; = 0.001). In the multivariate model, nephrectomy showed a significant association with OS (HR log rank 0.638; 95%CI 0.416 to 0.980), whereas gland metastases were still associated with better outcome in terms of both OS (HR log rank 0.487; 95%CI 0.279 to 0.852) and PFS (HR log rank 0.646; 95%CI 0.435 to 0.958).
CONCLUSIONS
IO treatment, in patients who had previously undergone nephrectomy, was associated with a better outcome in terms of OS. Further prospective trials would assess this issue in order to guide clinicians in real word practice.
背景
免疫肿瘤学（IO）可改善转移性肾细胞癌（mRCC）患者的总生存期（OS）。既往进行旨在治愈的减瘤性肾切除术（CN）和根治性肾切除术（RN）对接受IO治疗的患者的预后影响尚不明确。我们本文的目的是评估既往肾切除术对接受IO治疗的mRCC患者结局的影响。
方法
从隶属于MeetUro协会的16个意大利转诊中心回顾性收集了287例符合条件的患者。纳入接受IO作为二线和三线治疗的患者，而排除接受IO作为一线治疗的患者。采用Kaplan-Meier法和对数秩检验比较组间无进展生存期（PFS）和OS。在我们的分析中，CN和RN均被纳入。使用Cox比例风险模型在单变量和多变量分析中分析肾切除术与其他变量之间的关联。
结果
246/287（85.7%）例患者在接受IO治疗前进行了肾切除术。接受肾切除术的患者（246/287）的中位PFS为4.8个月（95%CI 3.9 - 5.7），而未接受肾切除术的患者为3.7个月（95%CI 1.9 - 5.5）（对数秩检验HR 0.78；95%CI 0.53至1.15；P = 0.186）。既往接受肾切除术的患者（246/287）的中位OS为20.9个月（95%CI 17.6 - 24.1），未接受肾切除术的患者为13个月（95%CI 7.7 - 18.2）（对数秩检验HR 0.504；95%CI 0.337至0.755；P = 0.001）。在多变量模型中，肾切除术与OS显示出显著关联（对数秩检验HR 0.638；95%CI 0.416至0.980），而腺转移在OS（对数秩检验HR 0.487；95%CI 0.279至0.852）和PFS（对数秩检验HR 0.646；95%CI 0.435至0.958）方面仍与较好的结局相关。
结论
既往接受过肾切除术的患者接受IO治疗，在OS方面与较好的结局相关。进一步的前瞻性试验将评估这个问题，以便在实际临床实践中指导临床医生。
Zotero 插件