McGill University, Montreal, Canada.
McGill University, Montreal, Canada.
Eur Urol Focus. 2022 Nov;8(6):1703-1710. doi: 10.1016/j.euf.2021.10.004. Epub 2021 Nov 1.
Treatment options for metastatic renal cell carcinoma (mRCC) include cytoreductive nephrectomy (CN) and systemic therapy (ST). Results from the CARMENA and SURTIME trials suggest that CN before ST may not be the optimal treatment strategy for mRCC.
To use real-world data to evaluate and compare outcomes for patients with mRCC who underwent CN before, after, or without ST to those patients who only received ST.
DESIGN, SETTING, AND PARTICIPANTS: The Canadian Kidney Cancer information system (CKCis) database was used to identify patients diagnosed with mRCC between January 2011 and April 2020. Only patients with synchronous disease, treated within 12 mo from their initial RCC diagnosis, with International Metastatic Renal Cell Carcinoma Database Consortium intermediate/high risk, and confirmed RCC histology were included.
Patients were classified into four groups according to the initial treatment received for mRCC. Inverse probability of treatment weighting using propensity scores was used to balance the treatment groups. Cox proportional hazards models were used to assess the impact of CN after adjusting for potential confounding variables in the weighted cohorts.
A total of 788 patients were included in the study cohort. Of these 383 patients underwent CN before ST, 73 underwent CN after ST, 80 underwent CN only, and 252 patients received ST only. The median patient age was 63 yr and 73% of the cohort were men. In weighted analysis, the groups undergoing CN before ST (hazard ratio [HR] 0.65, 95% confidence interval [CI] 0.52-0.82) and CN after ST (HR 0.41, 95% CI 0.28-0.60) both had better survival compared to the ST only group. No survival benefit was observed for CN only compared to ST only, or for CN before ST compared to CN after ST.
We evaluated the association between different sequences of treatment with CN and survival in patients with mRCC using CKCis real world data. The results demonstrate that the selected patients who undergo CN, whether performed before or after ST, have an associated improvement in survival.
Two of the treatment options for metastatic kidney cancer are surgery and systemic therapy (chemotherapy or immunotherapy). We used data from the Canadian Kidney Cancer information system to determine whether there are differences in survival according to the sequencing of these treatments. Patients who had both surgery and systemic therapy, regardless of which treatment was first, had better survival than patients who only received systemic therapy.
转移性肾细胞癌（mRCC）的治疗选择包括细胞减灭性肾切除术（CN）和系统治疗（ST）。CARMENA 和 SURTIME 试验的结果表明，CN 在前的 ST 可能不是 mRCC 的最佳治疗策略。
使用真实世界的数据来评估和比较接受 CN 治疗的 mRCC 患者与仅接受 ST 治疗的患者的结局。
设计、地点和参与者：加拿大肾脏癌信息系统（CKCis）数据库用于确定 2011 年 1 月至 2020 年 4 月期间诊断为 mRCC 的患者。仅包括同步疾病、从初始 RCC 诊断后 12 个月内接受治疗、国际转移性肾细胞癌数据库联盟中危/高危以及确认的 RCC 组织学的患者。
根据 mRCC 的初始治疗方式，患者被分为四组。使用倾向评分进行逆概率治疗加权以平衡治疗组。在加权队列中调整潜在混杂变量后，使用 Cox 比例风险模型评估 CN 的影响。
共纳入研究队列 788 例患者。其中 383 例患者在 ST 前接受 CN，73 例患者在 ST 后接受 CN，80 例患者仅接受 CN，252 例患者仅接受 ST。患者的中位年龄为 63 岁，队列中有 73%为男性。在加权分析中，与仅接受 ST 的组相比，在 ST 前接受 CN（风险比 [HR] 0.65，95%置信区间 [CI] 0.52-0.82）和在 ST 后接受 CN（HR 0.41，95% CI 0.28-0.60）的组的生存情况均有所改善。与仅接受 ST 的组相比，仅接受 CN 的组未观察到生存获益，或在 ST 前接受 CN 与 ST 后接受 CN 相比，也未观察到生存获益。
我们使用 CKCis 真实世界数据评估了 mRCC 患者不同 CN 治疗顺序与生存之间的关联。结果表明，接受 CN 的选定患者，无论 ST 治疗是在前还是在后，均与生存改善相关。
转移性肾癌的两种治疗选择是手术和系统治疗（化疗或免疫治疗）。我们使用加拿大肾脏癌信息系统的数据来确定根据这些治疗方法的先后顺序是否会对生存产生影响。接受手术和系统治疗的患者，无论哪种治疗方法在先，其生存率均高于仅接受系统治疗的患者。
