Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
Department of Surgery, University of Melbourne, Austin Hospital, Melbourne, Victoria, Australia.
Cancer. 2021 Nov 1;127(21):3946-3956. doi: 10.1002/cncr.33790. Epub 2021 Jul 19.
Systemic responses to cytoreductive nephrectomy (CN) in the management of metastatic renal cell carcinoma (mRCC) are variable and difficult to anticipate. The authors aimed to determine the association of CN with modifiable International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) risk factors and oncological outcomes.
Consecutive patients with mRCC referred for potential CN (2009-2019) were reviewed. The primary outcome was overall survival (OS); variables of interest included undergoing CN and the baseline number of modifiable IMDC risk factors (anemia, hypercalcemia, neutrophilia, thrombocytosis, and reduced performance status). For operative cases, the authors evaluated the effects of IMDC risk factor dynamics, measured 6 weeks and 6 months after CN, on OS and postoperative treatment disposition.
Of 245 treatment-naive patients with mRCC referred for CN, 177 (72%) proceeded to surgery. The CN cases had fewer modifiable IMDC risk factors (P = .003), including none in 71 of 177 patients (40.1%); fewer metastases (P = .011); and higher proportions of clear cell histology (P = .012). In a multivariable analysis, surgical selection, number of IMDC risk factors, metastatic focality, and histology were associated with OS. Total risk factors changed for 53.8% and 57.2% of the patients from the preoperative period to 6 weeks and 6 months after CN, respectively. Adjusted for preoperative IMDC risk scores, an increase in IMDC risk factors at 6 weeks and 6 months was associated with adverse OS (hazard ratio [HR], 1.57; 95% confidence interval [CI], 1.13-2.19; P = .007; HR, 2.52; 95% CI, 1.74-3.65; P < .001).
IMDC risk factors are dynamic clinical variables that can improve after upfront CN in select patients, and this suggests a systemic benefit of cytoreduction, which may confer clinically meaningful prognostic implications.
在转移性肾细胞癌(mRCC)的治疗中,细胞减灭性肾切除术(CN)引起的全身反应具有变异性且难以预测。作者旨在确定 CN 与可改变的国际转移性肾细胞癌数据库联盟(IMDC)风险因素和肿瘤学结局之间的关联。
回顾性分析了 2009 年至 2019 年期间因潜在 CN 而就诊的连续 mRCC 患者。主要结局为总生存(OS);感兴趣的变量包括接受 CN 和基线可改变的 IMDC 风险因素(贫血、高钙血症、中性粒细胞增多症、血小板增多症和体力状态降低)的数量。对于手术病例,作者评估了 CN 后 6 周和 6 个月时 IMDC 风险因素动态对 OS 和术后治疗处置的影响。
在 245 例接受 CN 治疗的初治 mRCC 患者中,177 例(72%)接受了手术。CN 组的可改变的 IMDC 风险因素较少(P=.003),包括 177 例患者中有 71 例(40.1%)无风险因素;转移灶较少(P=.011);和更高比例的透明细胞组织学(P=.012)。在多变量分析中,手术选择、IMDC 风险因素数量、转移灶局灶性和组织学与 OS 相关。从术前到 CN 后 6 周和 6 个月,分别有 53.8%和 57.2%的患者的总风险因素发生变化。调整术前 IMDC 风险评分后,6 周和 6 个月时 IMDC 风险因素的增加与不良 OS 相关(风险比 [HR],1.57;95%置信区间 [CI],1.13-2.19;P=.007;HR,2.52;95%CI,1.74-3.65;P <.001)。
IMDC 风险因素是动态的临床变量,在某些患者中,CN 后可改善,这表明细胞减灭术具有全身益处,可能具有有临床意义的预后意义。