McGill University Health Centre, McGill University, Montreal, QC H4A 3J1, Canada.
Cross Cancer Institute, University of Alberta, Edmonton, AB T6G 1Z2, Canada.
Curr Oncol. 2024 Aug 18;31(8):4704-4712. doi: 10.3390/curroncol31080351.
Immunotherapy-based systemic treatment (ST) is the standard of care for most patients diagnosed with metastatic renal cell carcinoma (mRCC). Cytoreductive nephrectomy (CN) has historically shown benefit for select patients with mRCC, but its role and timing are not well understood in the era of immunotherapy. The primary objective of this study is to assess outcomes in patients who received ST only, CN followed by ST (CN-ST), and ST followed by CN (ST-CN). The Canadian Kidney Cancer information system (CKCis) database was queried to identify patients with de novo mRCC who received immunotherapy-based ST between January 2014 and June 2023. These patients were classified into three categories as described above. Cox proportional hazards models were used to assess the impact of the timing of ST and CN on overall survival (OS) and progression-free survival (PFS), after adjusting for the International Metastatic RCC Database Consortium (IMDC) risk group, age, and comorbidities. Best overall response and complications of ST and CN for these cohorts were collected. A total of 588 patients were included in this study: 331 patients received ST only, 215 patients received CN-ST, and 42 patients received ST-CN. Patient and disease characteristics including age, gender, performance status, IMDC risk category, comorbidity, histology, type of ST, and metastatic sites are reported. OS analysis favored patients who received ST-CN (hazard ratio [HR] 0.30, 95% confidence interval [CI] 0.13-0.68) and CN-ST (HR 0.68, CI 0.47-0.97) over patients who received ST only. PFS analysis showed a similar trend for ST-CN (HR 0.45, CI 0.26-0.77) and CN-ST (HR 0.9, CI 0.68-1.17). This study examined baseline features and outcomes associated with the use and timing of CN and ST using real-world data via a large Canadian real-world cohort. Patients selected to receive CN after ST demonstrated improved outcomes. There were no appreciable differences in perioperative complications across groups. Limitations include the small number of patients in the ST-CN group and residual confounding and selection biases that may influence the outcomes in patients undergoing CN.
基于免疫疗法的系统治疗（ST）是大多数转移性肾细胞癌（mRCC）患者的标准治疗方法。减瘤性肾切除术（CN）在过去对选择的 mRCC 患者显示出益处，但在免疫治疗时代，其作用和时机尚不清楚。本研究的主要目的是评估仅接受 ST、CN 后接受 ST（CN-ST）和 ST 后接受 CN（ST-CN）的患者的结局。通过查询加拿大肾脏癌信息系统（CKCis）数据库，确定了 2014 年 1 月至 2023 年 6 月期间接受基于免疫疗法的 ST 治疗的新诊断为 mRCC 的患者。这些患者分为上述三种类型。使用 Cox 比例风险模型，在调整国际转移性肾细胞癌数据库联盟（IMDC）风险组、年龄和合并症后，评估 ST 和 CN 的时机对总生存（OS）和无进展生存（PFS）的影响。收集了这些队列中 ST 和 CN 的最佳总体反应和并发症。本研究共纳入 588 例患者：331 例仅接受 ST，215 例接受 CN-ST，42 例接受 ST-CN。报告了患者和疾病特征，包括年龄、性别、表现状态、IMDC 风险类别、合并症、组织学、ST 类型和转移部位。OS 分析有利于接受 ST-CN（风险比 [HR] 0.30，95%置信区间 [CI] 0.13-0.68）和 CN-ST（HR 0.68，CI 0.47-0.97）的患者，而不是仅接受 ST 的患者。PFS 分析显示，ST-CN（HR 0.45，CI 0.26-0.77）和 CN-ST（HR 0.9，CI 0.68-1.17）也有类似趋势。本研究使用来自大型加拿大真实世界队列的真实世界数据，检查了与 CN 和 ST 的使用和时机相关的基线特征和结果。接受 ST 后选择接受 CN 的患者显示出改善的结果。各组之间的围手术期并发症无明显差异。局限性包括 ST-CN 组患者人数较少，以及可能影响接受 CN 治疗的患者结局的残余混杂和选择偏倚。
