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Significance of upfront cytoreductive nephrectomy stratified by IMDC risk for metastatic renal cell carcinoma in targeted therapy era – a multi-institutional retrospective study
BACKGROUND: This retrospective multicenter study aimed to evaluate the survival benefit of upfront cytoreductive nephrectomy (CN) in metastatic renal cell carcinoma (RCC) patients stratified by International Metastatic RCC Database Consortium (IMDC) risk criteria. METHODS: We reviewed the medical re...
Autores principales: | , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Nature Singapore
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8882566/ https://www.ncbi.nlm.nih.gov/pubmed/34973106 http://dx.doi.org/10.1007/s10147-021-02091-8 |
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author | Kato, Renpei Naito, Sei Numakura, Kazuyuki Hatakeyama, Shingo Koguchi, Tomoyuki Kojima, Takahiro Kawasaki, Yoshihide Kandori, Shuya Kawamura, Sadafumi Arai, Yoichi Ito, Akihiro Nishiyama, Hiroyuki Kojima, Yoshiyuki Ohyama, Chikara Habuchi, Tomonori Tsuchiya, Norihiko Obara, Wataru |
author_facet | Kato, Renpei Naito, Sei Numakura, Kazuyuki Hatakeyama, Shingo Koguchi, Tomoyuki Kojima, Takahiro Kawasaki, Yoshihide Kandori, Shuya Kawamura, Sadafumi Arai, Yoichi Ito, Akihiro Nishiyama, Hiroyuki Kojima, Yoshiyuki Ohyama, Chikara Habuchi, Tomonori Tsuchiya, Norihiko Obara, Wataru |
author_sort | Kato, Renpei |
collection | PubMed |
description | BACKGROUND: This retrospective multicenter study aimed to evaluate the survival benefit of upfront cytoreductive nephrectomy (CN) in metastatic renal cell carcinoma (RCC) patients stratified by International Metastatic RCC Database Consortium (IMDC) risk criteria. METHODS: We reviewed the medical records in the Michinoku Database between 2008 and 2019. Patients who received upfront CN, systemic therapy without CN (no CN) and CN after drug therapy (deferred CN) were analyzed. To exclude selection bias due to patient characteristics, baseline clinical data were adjusted by inverse probability of treatment weighting (IPTW). Overall survival (OS) was compared between upfront CN and non-upfront CN (no CN plus deferred CN). Associations between time-varying covariates including systemic therapies and OS stratified by IMDC risk criteria were analyzed by IPTW-adjusted Cox regression method. RESULTS: Of 259 patients who fulfilled the selection criteria, 107 were classified in upfront CN and 152 in non-upfront CN group. After IPTW-adjusted analysis, upfront CN showed survival benefit compared to non-upfront CN in patients with IMDC intermediate risk (median OS: 52.5 versus 31.3 months, p < 0.01) and in patients with IMDC poor risk (27.2 versus 11.4 months, p < 0.01). In IPTW-adjusted Cox regression analysis of time-varying covariates, upfront CN was independently associated with OS benefit in patients with IMDC intermediate risk (hazard ratio 0.52, 95% confidence interval 0.29–0.93, p = 0.03) and in patients with IMDC poor risk (0.26, 0.11–0.59, p < 0.01). CONCLUSIONS: Upfront CN may confer survival benefit in RCC patients with IMDC intermediate and poor risk. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10147-021-02091-8. |
format | Online Article Text |
id | pubmed-8882566 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Springer Nature Singapore |
record_format | MEDLINE/PubMed |
spelling | pubmed-88825662022-03-02 Significance of upfront cytoreductive nephrectomy stratified by IMDC risk for metastatic renal cell carcinoma in targeted therapy era – a multi-institutional retrospective study Kato, Renpei Naito, Sei Numakura, Kazuyuki Hatakeyama, Shingo Koguchi, Tomoyuki Kojima, Takahiro Kawasaki, Yoshihide Kandori, Shuya Kawamura, Sadafumi Arai, Yoichi Ito, Akihiro Nishiyama, Hiroyuki Kojima, Yoshiyuki Ohyama, Chikara Habuchi, Tomonori Tsuchiya, Norihiko Obara, Wataru Int J Clin Oncol Original Article BACKGROUND: This retrospective multicenter study aimed to evaluate the survival benefit of upfront cytoreductive nephrectomy (CN) in metastatic renal cell carcinoma (RCC) patients stratified by International Metastatic RCC Database Consortium (IMDC) risk criteria. METHODS: We reviewed the medical records in the Michinoku Database between 2008 and 2019. Patients who received upfront CN, systemic therapy without CN (no CN) and CN after drug therapy (deferred CN) were analyzed. To exclude selection bias due to patient characteristics, baseline clinical data were adjusted by inverse probability of treatment weighting (IPTW). Overall survival (OS) was compared between upfront CN and non-upfront CN (no CN plus deferred CN). Associations between time-varying covariates including systemic therapies and OS stratified by IMDC risk criteria were analyzed by IPTW-adjusted Cox regression method. RESULTS: Of 259 patients who fulfilled the selection criteria, 107 were classified in upfront CN and 152 in non-upfront CN group. After IPTW-adjusted analysis, upfront CN showed survival benefit compared to non-upfront CN in patients with IMDC intermediate risk (median OS: 52.5 versus 31.3 months, p < 0.01) and in patients with IMDC poor risk (27.2 versus 11.4 months, p < 0.01). In IPTW-adjusted Cox regression analysis of time-varying covariates, upfront CN was independently associated with OS benefit in patients with IMDC intermediate risk (hazard ratio 0.52, 95% confidence interval 0.29–0.93, p = 0.03) and in patients with IMDC poor risk (0.26, 0.11–0.59, p < 0.01). CONCLUSIONS: Upfront CN may confer survival benefit in RCC patients with IMDC intermediate and poor risk. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10147-021-02091-8. Springer Nature Singapore 2022-01-01 2022 /pmc/articles/PMC8882566/ /pubmed/34973106 http://dx.doi.org/10.1007/s10147-021-02091-8 Text en © The Author(s) 2021, corrected publication 2023 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . |
spellingShingle | Original Article Kato, Renpei Naito, Sei Numakura, Kazuyuki Hatakeyama, Shingo Koguchi, Tomoyuki Kojima, Takahiro Kawasaki, Yoshihide Kandori, Shuya Kawamura, Sadafumi Arai, Yoichi Ito, Akihiro Nishiyama, Hiroyuki Kojima, Yoshiyuki Ohyama, Chikara Habuchi, Tomonori Tsuchiya, Norihiko Obara, Wataru Significance of upfront cytoreductive nephrectomy stratified by IMDC risk for metastatic renal cell carcinoma in targeted therapy era – a multi-institutional retrospective study |
title | Significance of upfront cytoreductive nephrectomy stratified by IMDC risk for metastatic renal cell carcinoma in targeted therapy era – a multi-institutional retrospective study |
title_full | Significance of upfront cytoreductive nephrectomy stratified by IMDC risk for metastatic renal cell carcinoma in targeted therapy era – a multi-institutional retrospective study |
title_fullStr | Significance of upfront cytoreductive nephrectomy stratified by IMDC risk for metastatic renal cell carcinoma in targeted therapy era – a multi-institutional retrospective study |
title_full_unstemmed | Significance of upfront cytoreductive nephrectomy stratified by IMDC risk for metastatic renal cell carcinoma in targeted therapy era – a multi-institutional retrospective study |
title_short | Significance of upfront cytoreductive nephrectomy stratified by IMDC risk for metastatic renal cell carcinoma in targeted therapy era – a multi-institutional retrospective study |
title_sort | significance of upfront cytoreductive nephrectomy stratified by imdc risk for metastatic renal cell carcinoma in targeted therapy era – a multi-institutional retrospective study |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8882566/ https://www.ncbi.nlm.nih.gov/pubmed/34973106 http://dx.doi.org/10.1007/s10147-021-02091-8 |
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