Cytoreductive nephrectomy for metastatic renal cell carcinoma in the era of targeted therapy in the United States: a SEER analysis.
Cytoreductive nephrectomy for metastatic renal cell carcinoma in the era of targeted therapy in the United States: a SEER analysis.
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DOI：
10.1007/s00345-012-1001-3
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发表时间：
2013-12
影响因子：
3.4
通讯作者：
Galsky MD
中科院分区：
文献类型：
--
作者：
Tsao CK;Small AC;Kates M;Moshier EL;Wisnivesky JP;Gartrell BA;Sonpavde G;Godbold JH;Palese MA;Hall SJ;Oh WK;Galsky MD
2001年发表的两项随机试验为转移性肾细胞癌（mRCC）的使用提供了一级证据。然而，血管内皮生长因子酪氨酸激酶抑制剂（VEGFR-TKI）于2005年获得监管部门批准，这给CyNx的使用留下了“证据空白”。我们评估了CyNx在细胞因子和VEGFR-TKI时代的使用模式，以及与CyNx使用相关的患者特征。监测、流行病学和最终结果登记用于鉴定2001年至2008年间组织学或细胞学确诊的IV期RCC患者。患者在细胞因子（2001-2005）或VEGFR-TKI（2006-2008）时代进行治疗。根据治疗时间和社会经济特征进行多因素logistic回归分析，计算接受CyNx的几率。总的来说，2448例患者中有1112例（45%）接受了CyNx治疗。从2001年到2005年，CyNx的使用率保持稳定（50%），但在2008年下降到38%。Logistic回归分析显示，年龄较大（OR 0.82, 95% CI: 0.68, 0.99）、黑人（OR 0.64, 95% CI: 0.46, 0.91）、西班牙裔（OR 0.71, 95% CI: 0.54, 0.93）和VEGFR-TKI时代的治疗（OR 0.82, 95% CI: 0.68, 0.99）与CyNx的使用减少独立相关。在美国，在VEGFR-TKI时代，CyNx的使用有所下降。老年患者和少数族裔患者接受CyNx的可能性较小。需要正在进行的III期试验的结果来完善这种治疗方式的作用。
Two randomized trials published in 2001 provided level 1 evidence for the use of cytoreductive nephrectomy (CyNx) for the treatment of metastatic renal cell carcinoma (mRCC). However, the regulatory approval of vascular endothelial growth factor tyrosine kinase inhibitors (VEGFR-TKI) in 2005 has left an “evidence void” regarding the use of CyNx. We evaluated the patterns in the use of CyNx in the cytokine and VEGFR-TKI eras, and the patient characteristics associated with the use of CyNx. The Surveillance, Epidemiology, and End Results registry was used to identify patients with histologically or cytologically confirmed stage IV RCC between 2001 and 2008. Patients were classified as treated during the cytokine (2001–2005) or VEGFR-TKI (2006–2008) eras. A multivariate logistic regression analysis was performed to calculate the odds of undergoing CyNx according to treatment era and socioeconomic characteristics. Overall, 1,112 of 2,448 patients (45 %) underwent CyNx. CyNx use remained stable between 2001 and 2005 (50 %), but decreased to 38 % in 2008. Logistic regression analysis revealed that older age (OR 0.82, 95 % CI: 0.68, 0.99), black race (OR 0.64, 95 % CI: 0.46, 0.91), Hispanic ethnicity (OR 0.71, 95 % CI: 0.54, 0.93), and treatment in the VEGFR-TKI era (OR 0.82, 95 % CI: 0.68, 0.99) were independently associated with decreased use of CyNx. Use of CyNx in the United States has declined in the VEGFR-TKI era. Older patients and minorities are less likely to receive CyNx. Results of ongoing phase III trials are needed to refine the role of this treatment modality.