The Impact of Cytoreductive Nephrectomy on Survival of Patients With Metastatic Renal Cell Carcinoma Receiving Vascular Endothelial Growth Factor Targeted Therapy
The Impact of Cytoreductive Nephrectomy on Survival of Patients With Metastatic Renal Cell Carcinoma Receiving Vascular Endothelial Growth Factor Targeted Therapy
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DOI：
10.1016/j.juro.2010.09.012
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发表时间：
2011-01-01
影响因子：
6.6
通讯作者：
Heng, Daniel Y. C.
中科院分区：
文献类型：
--
作者：
Choueiri, Toni K.;Xie, Wanling;Heng, Daniel Y. C.
目的：血管内皮生长因子靶向治疗是转移性肾细胞癌患者的标准治疗。肿瘤细胞减少性肾切除术在新药物时代的作用仍然不明确。材料和方法：我们回顾性分析了来自美国和加拿大癌症中心的314例未经抗血管内皮生长因子治疗的转移性肾细胞癌患者的基线特征和结局，以研究肿瘤细胞减少性肾切除术对总生存率的影响。行细胞减灭性肾切除术的患者（201例）（p < 0.01），并且更有可能具有更好的Karnofsky性能状态（p < 0.01）、1个以上转移部位（p = 0.04）和较低的校正钙水平（p < 0.01）。单变量分析显示，肿瘤细胞减灭性肾切除术患者的中位总生存期为19.8个月，而未行肿瘤细胞减灭性肾切除术患者的中位总生存期为9.4个月（HR 0.44; 95%CI 0.32，0.59; p < 0.01）。在多变量分析和调整已建立的预后危险因素后，总生存期差异持续存在（调整后HR 0.68; 95%CI 0.46，0.99; p < 0.04），有利于肿瘤细胞减少性肾切除术组。在按有利/中等/不良风险标准分层的亚组分析中，不良风险组的患者获益甚微（p = 0.06）。同样，Karnofsky性能状态低于80%的患者也有一个边际生存效益（p = 0.08）conclusions：在这项回顾性研究中，细胞减灭性肾切除术与血管内皮生长因子靶向药物治疗的转移性肾细胞癌患者的总生存期延长独立相关，尽管这些患者的风险特征差的好处是边际的。
Purpose: Vascular endothelial growth factor targeted therapy is a standard of care in patients with metastatic renal cell carcinoma. The role of cytoreductive nephrectomy in the era of novel agents remains poorly defined.Materials and Methods: We retrospectively reviewed baseline characteristics and outcomes of 314 patients with anti-vascular endothelial growth factor therapy naive, metastatic renal cell carcinoma from United States and Canadian cancer centers to study the impact of cytoreductive nephrectomy on overall survival.Results: Patients who underwent cytoreductive nephrectomy (201) were younger (p < 0.01), and more likely to have a better Karnofsky performance status (p < 0.01), more than 1 site of metastasis (p = 0.04) and lower corrected calcium levels (p < 0.01) compared to those who did not undergo cytoreductive nephrectomy (113). On univariable analysis cytoreductive nephrectomy was associated with a median overall survival of 19.8 months compared to 9.4 months for patients who did not undergo cytoreductive nephrectomy (HR 0.44; 95% CI 0.32, 0.59; p < 0.01). On multivariable analysis and adjusting for established prognostic risk factors the overall survival difference persisted (adjusted HR 0.68; 95% CI 0.46, 0.99; p < 0.04) in favor of the cytoreductive nephrectomy group. In subgroup analyses stratified for favorable/intermediate/poor risk criteria, patients in the poor risk group had a marginal benefit (p = 0.06). Similarly patients with Karnofsky performance status less than 80% also had a marginal survival benefit (p = 0.08).Conclusions: In this retrospective study cytoreductive nephrectomy was independently associated with a prolonged overall survival of patients with metastatic renal cell carcinoma treated with vascular endothelial growth factor targeted agents, although the benefit is marginal in those patients with poor risk features.