Cytoreductive nephrectomy in patients with metastatic non-clear-cell renal cell carcinoma (RCC).
Cytoreductive nephrectomy in patients with metastatic non-clear-cell renal cell carcinoma (RCC).
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DOI：
10.1111/bju.12442
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发表时间：
2014-05
影响因子：
4.5
通讯作者：
Choueiri TK
中科院分区：
文献类型：
--
作者：
Aizer AA;Urun Y;McKay RR;Kibel AS;Nguyen PL;Choueiri TK
确定转移性非透明细胞肾细胞癌（RCC）患者是否受益于细胞减灭性肾切除术（CN）。我们使用了监测、流行病学和最终结果（SEER）计划，以确定2000年至2009年期间诊断为转移性RCC的4914例患者的基于人群的样本。在4914例患者中，591例为非透明细胞组织学。中位随访时间为20个月。主要结局指标为RCC特异性死亡率。大约64%的患者接受CN。接受CN的非透明细胞组织学患者的RCC特异性死亡率和全因死亡率低于未接受CN的患者（两种情况下P < 0.001）。在对年龄、性别、种族、婚姻状况、诊断年份、地理位置和组织学进行调整后，CN与较低的RCC特异性死亡率之间的关系（风险比[HR] 0.62，95%置信区间[CI] 0.48-0.80，P < 0.001）和CN与全因死亡率之间的差异（HR 0.45，95% CI 0.37-0.55，P < 0.001）仍高度显著。在2006年至2009年（靶向治疗时代）诊断的患者中，结果保持不变（分别为HR 0.50，95% CI 0.34-0.72，P < 0.001和HR 0.43，95% CI 0.31-0.59，P < 0.001）。交互作用模型发现CN后所有组织学的全因死亡率较低。来自SEER项目的转移性非透明细胞RCC患者，包括在靶向治疗时代接受治疗的患者，似乎从CN中获得生存益处，无论组织学亚型如何，这种关联仍然显着。这一观察结果表明，CN应保持标准的晚期RCC患者谁被认为是手术候选人。
To determine whether patients with metastatic non-clear-cell renal cell carcinoma (RCC) benefit from cytoreductive nephrectomy (CN). We used the Surveillance, Epidemiology, and End Results (SEER) programme to identify a population-based sample of 4914 patients diagnosed with metastatic RCC between 2000 and 2009. Of the 4914 patients, 591 had non-clear-cell histology. The median follow-up was 20 months. The primary outcome measure was RCC-specific mortality. Approximately 64% of patients underwent CN. Patients with non-clear-cell histology who underwent CN had lower RCC-specific and all-cause mortality than those who did not (P < 0.001 in both cases). After adjustment for age, gender, race, marital status, year of diagnosis, geographical location and histology, the associations between CN and lower RCC-specific mortality (hazard ratio [HR] 0.62, 95% confidence interval [CI] 0.48–0.80, P < 0.001) and between CN and all-cause mortality (HR 0.45, 95% CI 0.37–0.55, P < 0.001) remained highly significant. Among patients diagnosed between 2006 and 2009 (targeted therapy era), the results remained unchanged (HR 0.50, 95% CI 0.34–0.72, P < 0.001 and HR 0.43, 95% CI 0.31–0.59, P < 0.001, respectively). An interaction model found lower all-cause mortality for all histologies after CN. Patients from the SEER programme with metastatic non-clear-cell RCC, including those treated in the targeted therapy era, appear to derive a survival benefit from CN, an association which remained significant regardless of histological subtype. This observation suggests that CN should remain standard in patients with advanced RCC who are deemed to be surgical candidates.
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影响因子：
8.4
作者：
Aben, K. K. H.;Heskamp, S.;van Spronsen, D. J.
通讯作者：
van Spronsen, D. J.
DOI：
10.1016/j.juro.2009.07.049
发表时间：
2009-11
期刊：
The Journal of urology
影响因子：
--
作者：
Shuch B;Said J;La Rochelle JC;Zhou Y;Li G;Klatte T;Kabbinaavar FF;Pantuck AJ;Belldegrun AS
通讯作者：
Belldegrun AS
影响因子：
168.9
作者：
Mickisch, GHJ;Garin, A;Sylvester, R
通讯作者：
Sylvester, R
影响因子：
2.1
作者：
Zini, Laurent;Capitanio, Umberto;Karakiewicz, Pierre I.
通讯作者：
Karakiewicz, Pierre I.
影响因子：
4.8
作者：
Scrucca, L.;Santucci, A.;Aversa, F.
通讯作者：
Aversa, F.