Cytoreductive Nephrectomy in Metastatic Papillary Renal Cell Carcinoma: Results from the International Metastatic Renal Cell Carcinoma Database Consortium

Jeffrey Graham, J. Connor Wells, Frede Donskov, Jae Lyun Lee, Anna Fraccon, Felice Pasini, Camillo Porta, I. Alex Bowman, Georg A. Bjarnason, D. Scott Ernst, Sun Young Rha, Benoit Beuselinck, Aaron Hansen, Scott A. North, Christian K. Kollmannsberger, Lori A. Wood, Ulka N. Vaishampayan, Sumanta K. Pal, Toni K. Choueiri, Daniel Y.C. Heng

Research output: Contribution to journalArticle

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Abstract

BACKGROUND: There is evidence that cytoreductive nephrectomy (CN) may be beneficial in metastatic renal cell carcinoma (mRCC). This has been studied predominantly in clear-cell RCC, with more limited data on the role of CN in patients with papillary histology. OBJECTIVE: To determine the benefit of CN in synchronous metastatic papillary RCC. DESIGN, SETTING, AND PARTICIPANTS: Using the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) database, a retrospective analysis was performed for patients with papillary mRCC treated with or without CN. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Median overall survival (OS) and progression-free survival (PFS) were determined for both patient groups. Cox regression analysis was performed to control for imbalances in individual IMDC risk factors. RESULTS AND LIMITATIONS: In total, 647 patients with papillary mRCC were identified, of whom 353 had synchronous metastatic disease. Of these, 109 patients were treated with CN and 244 were not. The median follow-up was 57.1mo (95% confidence interval [CI] 32.9-77.8) and the OS from the start of first-line targeted therapy for the entire cohort was 13.2mo (95% CI 12.0-16.1). Median OS for patients with CN was 16.3mo, compared to 8.6mo (p<0.0001) in the no-CN group. When adjusted for individual IMDC risk factors, the hazard ratio (HR) of death for CN was 0.62 (95% CI 0.45-0.85; p=0.0031). Limitations include the retrospective nature of the analysis. CONCLUSIONS: The use of CN in patients with mRCC and papillary histology appears to be associated with better survival compared to no CN after adjustment for risk criteria. Selection of appropriate candidates for CN is crucial. A clinical trial in this rare population may not be possible. PATIENT SUMMARY: In a population of patients with advanced papillary kidney cancer, we found that surgical removal of the primary kidney tumor was associated with better overall survival.

Original languageEnglish
Pages (from-to)643-648
Number of pages6
JournalEuropean urology oncology
Volume2
Issue number6
DOIs
Publication statusPublished - 2019 Nov 1

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Nephrectomy
Renal Cell Carcinoma
Databases
Survival
Confidence Intervals
Histology
Risk Adjustment
Kidney Neoplasms
Population
Disease-Free Survival
Regression Analysis
Clinical Trials
Kidney

All Science Journal Classification (ASJC) codes

  • Surgery
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Urology

Cite this

Graham, Jeffrey ; Wells, J. Connor ; Donskov, Frede ; Lee, Jae Lyun ; Fraccon, Anna ; Pasini, Felice ; Porta, Camillo ; Bowman, I. Alex ; Bjarnason, Georg A. ; Ernst, D. Scott ; Rha, Sun Young ; Beuselinck, Benoit ; Hansen, Aaron ; North, Scott A. ; Kollmannsberger, Christian K. ; Wood, Lori A. ; Vaishampayan, Ulka N. ; Pal, Sumanta K. ; Choueiri, Toni K. ; Heng, Daniel Y.C. / Cytoreductive Nephrectomy in Metastatic Papillary Renal Cell Carcinoma : Results from the International Metastatic Renal Cell Carcinoma Database Consortium. In: European urology oncology. 2019 ; Vol. 2, No. 6. pp. 643-648.
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title = "Cytoreductive Nephrectomy in Metastatic Papillary Renal Cell Carcinoma: Results from the International Metastatic Renal Cell Carcinoma Database Consortium",
abstract = "BACKGROUND: There is evidence that cytoreductive nephrectomy (CN) may be beneficial in metastatic renal cell carcinoma (mRCC). This has been studied predominantly in clear-cell RCC, with more limited data on the role of CN in patients with papillary histology. OBJECTIVE: To determine the benefit of CN in synchronous metastatic papillary RCC. DESIGN, SETTING, AND PARTICIPANTS: Using the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) database, a retrospective analysis was performed for patients with papillary mRCC treated with or without CN. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Median overall survival (OS) and progression-free survival (PFS) were determined for both patient groups. Cox regression analysis was performed to control for imbalances in individual IMDC risk factors. RESULTS AND LIMITATIONS: In total, 647 patients with papillary mRCC were identified, of whom 353 had synchronous metastatic disease. Of these, 109 patients were treated with CN and 244 were not. The median follow-up was 57.1mo (95{\%} confidence interval [CI] 32.9-77.8) and the OS from the start of first-line targeted therapy for the entire cohort was 13.2mo (95{\%} CI 12.0-16.1). Median OS for patients with CN was 16.3mo, compared to 8.6mo (p<0.0001) in the no-CN group. When adjusted for individual IMDC risk factors, the hazard ratio (HR) of death for CN was 0.62 (95{\%} CI 0.45-0.85; p=0.0031). Limitations include the retrospective nature of the analysis. CONCLUSIONS: The use of CN in patients with mRCC and papillary histology appears to be associated with better survival compared to no CN after adjustment for risk criteria. Selection of appropriate candidates for CN is crucial. A clinical trial in this rare population may not be possible. PATIENT SUMMARY: In a population of patients with advanced papillary kidney cancer, we found that surgical removal of the primary kidney tumor was associated with better overall survival.",
author = "Jeffrey Graham and Wells, {J. Connor} and Frede Donskov and Lee, {Jae Lyun} and Anna Fraccon and Felice Pasini and Camillo Porta and Bowman, {I. Alex} and Bjarnason, {Georg A.} and Ernst, {D. Scott} and Rha, {Sun Young} and Benoit Beuselinck and Aaron Hansen and North, {Scott A.} and Kollmannsberger, {Christian K.} and Wood, {Lori A.} and Vaishampayan, {Ulka N.} and Pal, {Sumanta K.} and Choueiri, {Toni K.} and Heng, {Daniel Y.C.}",
year = "2019",
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language = "English",
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pages = "643--648",
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Graham, J, Wells, JC, Donskov, F, Lee, JL, Fraccon, A, Pasini, F, Porta, C, Bowman, IA, Bjarnason, GA, Ernst, DS, Rha, SY, Beuselinck, B, Hansen, A, North, SA, Kollmannsberger, CK, Wood, LA, Vaishampayan, UN, Pal, SK, Choueiri, TK & Heng, DYC 2019, 'Cytoreductive Nephrectomy in Metastatic Papillary Renal Cell Carcinoma: Results from the International Metastatic Renal Cell Carcinoma Database Consortium', European urology oncology, vol. 2, no. 6, pp. 643-648. https://doi.org/10.1016/j.euo.2019.03.007

Cytoreductive Nephrectomy in Metastatic Papillary Renal Cell Carcinoma : Results from the International Metastatic Renal Cell Carcinoma Database Consortium. / Graham, Jeffrey; Wells, J. Connor; Donskov, Frede; Lee, Jae Lyun; Fraccon, Anna; Pasini, Felice; Porta, Camillo; Bowman, I. Alex; Bjarnason, Georg A.; Ernst, D. Scott; Rha, Sun Young; Beuselinck, Benoit; Hansen, Aaron; North, Scott A.; Kollmannsberger, Christian K.; Wood, Lori A.; Vaishampayan, Ulka N.; Pal, Sumanta K.; Choueiri, Toni K.; Heng, Daniel Y.C.

In: European urology oncology, Vol. 2, No. 6, 01.11.2019, p. 643-648.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Cytoreductive Nephrectomy in Metastatic Papillary Renal Cell Carcinoma

T2 - Results from the International Metastatic Renal Cell Carcinoma Database Consortium

AU - Graham, Jeffrey

AU - Wells, J. Connor

AU - Donskov, Frede

AU - Lee, Jae Lyun

AU - Fraccon, Anna

AU - Pasini, Felice

AU - Porta, Camillo

AU - Bowman, I. Alex

AU - Bjarnason, Georg A.

AU - Ernst, D. Scott

AU - Rha, Sun Young

AU - Beuselinck, Benoit

AU - Hansen, Aaron

AU - North, Scott A.

AU - Kollmannsberger, Christian K.

AU - Wood, Lori A.

AU - Vaishampayan, Ulka N.

AU - Pal, Sumanta K.

AU - Choueiri, Toni K.

AU - Heng, Daniel Y.C.

PY - 2019/11/1

Y1 - 2019/11/1

N2 - BACKGROUND: There is evidence that cytoreductive nephrectomy (CN) may be beneficial in metastatic renal cell carcinoma (mRCC). This has been studied predominantly in clear-cell RCC, with more limited data on the role of CN in patients with papillary histology. OBJECTIVE: To determine the benefit of CN in synchronous metastatic papillary RCC. DESIGN, SETTING, AND PARTICIPANTS: Using the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) database, a retrospective analysis was performed for patients with papillary mRCC treated with or without CN. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Median overall survival (OS) and progression-free survival (PFS) were determined for both patient groups. Cox regression analysis was performed to control for imbalances in individual IMDC risk factors. RESULTS AND LIMITATIONS: In total, 647 patients with papillary mRCC were identified, of whom 353 had synchronous metastatic disease. Of these, 109 patients were treated with CN and 244 were not. The median follow-up was 57.1mo (95% confidence interval [CI] 32.9-77.8) and the OS from the start of first-line targeted therapy for the entire cohort was 13.2mo (95% CI 12.0-16.1). Median OS for patients with CN was 16.3mo, compared to 8.6mo (p<0.0001) in the no-CN group. When adjusted for individual IMDC risk factors, the hazard ratio (HR) of death for CN was 0.62 (95% CI 0.45-0.85; p=0.0031). Limitations include the retrospective nature of the analysis. CONCLUSIONS: The use of CN in patients with mRCC and papillary histology appears to be associated with better survival compared to no CN after adjustment for risk criteria. Selection of appropriate candidates for CN is crucial. A clinical trial in this rare population may not be possible. PATIENT SUMMARY: In a population of patients with advanced papillary kidney cancer, we found that surgical removal of the primary kidney tumor was associated with better overall survival.

AB - BACKGROUND: There is evidence that cytoreductive nephrectomy (CN) may be beneficial in metastatic renal cell carcinoma (mRCC). This has been studied predominantly in clear-cell RCC, with more limited data on the role of CN in patients with papillary histology. OBJECTIVE: To determine the benefit of CN in synchronous metastatic papillary RCC. DESIGN, SETTING, AND PARTICIPANTS: Using the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) database, a retrospective analysis was performed for patients with papillary mRCC treated with or without CN. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Median overall survival (OS) and progression-free survival (PFS) were determined for both patient groups. Cox regression analysis was performed to control for imbalances in individual IMDC risk factors. RESULTS AND LIMITATIONS: In total, 647 patients with papillary mRCC were identified, of whom 353 had synchronous metastatic disease. Of these, 109 patients were treated with CN and 244 were not. The median follow-up was 57.1mo (95% confidence interval [CI] 32.9-77.8) and the OS from the start of first-line targeted therapy for the entire cohort was 13.2mo (95% CI 12.0-16.1). Median OS for patients with CN was 16.3mo, compared to 8.6mo (p<0.0001) in the no-CN group. When adjusted for individual IMDC risk factors, the hazard ratio (HR) of death for CN was 0.62 (95% CI 0.45-0.85; p=0.0031). Limitations include the retrospective nature of the analysis. CONCLUSIONS: The use of CN in patients with mRCC and papillary histology appears to be associated with better survival compared to no CN after adjustment for risk criteria. Selection of appropriate candidates for CN is crucial. A clinical trial in this rare population may not be possible. PATIENT SUMMARY: In a population of patients with advanced papillary kidney cancer, we found that surgical removal of the primary kidney tumor was associated with better overall survival.

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