Cytoreductive nephrectomy in patients with synchronous metastases from renal cell carcinoma: Results from the International Metastatic Renal Cell Carcinoma Database Consortium

Daniel Y.C. Heng, J. Connor Wells, Brian I. Rini, Benoit Beuselinck, Jae Lyun Lee, Jennifer J. Knox, Georg A. Bjarnason, Sumanta Kumar Pal, Christian K. Kollmannsberger, Takeshi Yuasa, Sandy Srinivas, Frede Donskov, Aristotelis Bamias, Lori A. Wood, D. Scott Ernst, Neeraj Agarwal, Ulka N. Vaishampayan, Sun Young Rha, Jenny J. Kim, Toni K. Choueiri

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Abstract

Background The benefit of cytoreductive nephrectomy (CN) for overall survival (OS) is unclear in patients with synchronous metastatic renal cell carcinoma (mRCC) in the era of targeted therapy. Objective To determine OS benefit of CN compared with no CN in mRCC patients treated with targeted therapies. Design, setting, and participants Retrospective data from patients with synchronous mRCC (n = 1658) from the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) were used to compare 982 mRCC patients who had a CN with 676 mRCC patients who did not. Outcome measurements and statistical analysis OS was compared and hazard ratios (HRs) adjusted for IMDC poor prognostic criteria. Results and limitations Patients who had CN had better IMDC prognostic profiles versus those without (favorable, intermediate, or poor in 9%, 63%, and 28% vs 1%, 45%, and 54%, respectively). The median OS of patients with CN versus without CN was 20.6 versus 9.5 mo (p < 0.0001). When adjusted for IMDC criteria to correct for imbalances, the HR of death was 0.60 (95% confidence interval, 0.52-0.69; p < 0.0001). Patients estimated to survive <12 mo may receive marginal benefit from CN. Patients who have four or more of the IMDC prognostic criteria did not benefit from CN. Data were collected retrospectively. Conclusions CN is beneficial in synchronous mRCC patients treated with targeted therapy, even after adjusting for prognostic factors. Patients with estimated survival times <12 mo or four or more IMDC prognostic factors may not benefit from CN. This information may aid in patient selection as we await results from randomized controlled trials. Patient summary We looked at the survival outcomes of metastatic renal cell carcinoma patients who did or did not have the primary tumor removed. We found that most patients benefited from tumor removal, except for those with four or more IMDC risk factors.

Original languageEnglish
Pages (from-to)704-710
Number of pages7
JournalEuropean Urology
Volume66
Issue number4
DOIs
Publication statusPublished - 2014 Oct

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Nephrectomy
Renal Cell Carcinoma
Databases
Neoplasm Metastasis
Survival
Survival Analysis
Patient Selection
Neoplasms
Therapeutics
Randomized Controlled Trials
Confidence Intervals

All Science Journal Classification (ASJC) codes

  • Urology

Cite this

Heng, Daniel Y.C. ; Wells, J. Connor ; Rini, Brian I. ; Beuselinck, Benoit ; Lee, Jae Lyun ; Knox, Jennifer J. ; Bjarnason, Georg A. ; Pal, Sumanta Kumar ; Kollmannsberger, Christian K. ; Yuasa, Takeshi ; Srinivas, Sandy ; Donskov, Frede ; Bamias, Aristotelis ; Wood, Lori A. ; Ernst, D. Scott ; Agarwal, Neeraj ; Vaishampayan, Ulka N. ; Rha, Sun Young ; Kim, Jenny J. ; Choueiri, Toni K. / Cytoreductive nephrectomy in patients with synchronous metastases from renal cell carcinoma : Results from the International Metastatic Renal Cell Carcinoma Database Consortium. In: European Urology. 2014 ; Vol. 66, No. 4. pp. 704-710.
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title = "Cytoreductive nephrectomy in patients with synchronous metastases from renal cell carcinoma: Results from the International Metastatic Renal Cell Carcinoma Database Consortium",
abstract = "Background The benefit of cytoreductive nephrectomy (CN) for overall survival (OS) is unclear in patients with synchronous metastatic renal cell carcinoma (mRCC) in the era of targeted therapy. Objective To determine OS benefit of CN compared with no CN in mRCC patients treated with targeted therapies. Design, setting, and participants Retrospective data from patients with synchronous mRCC (n = 1658) from the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) were used to compare 982 mRCC patients who had a CN with 676 mRCC patients who did not. Outcome measurements and statistical analysis OS was compared and hazard ratios (HRs) adjusted for IMDC poor prognostic criteria. Results and limitations Patients who had CN had better IMDC prognostic profiles versus those without (favorable, intermediate, or poor in 9{\%}, 63{\%}, and 28{\%} vs 1{\%}, 45{\%}, and 54{\%}, respectively). The median OS of patients with CN versus without CN was 20.6 versus 9.5 mo (p < 0.0001). When adjusted for IMDC criteria to correct for imbalances, the HR of death was 0.60 (95{\%} confidence interval, 0.52-0.69; p < 0.0001). Patients estimated to survive <12 mo may receive marginal benefit from CN. Patients who have four or more of the IMDC prognostic criteria did not benefit from CN. Data were collected retrospectively. Conclusions CN is beneficial in synchronous mRCC patients treated with targeted therapy, even after adjusting for prognostic factors. Patients with estimated survival times <12 mo or four or more IMDC prognostic factors may not benefit from CN. This information may aid in patient selection as we await results from randomized controlled trials. Patient summary We looked at the survival outcomes of metastatic renal cell carcinoma patients who did or did not have the primary tumor removed. We found that most patients benefited from tumor removal, except for those with four or more IMDC risk factors.",
author = "Heng, {Daniel Y.C.} and Wells, {J. Connor} and Rini, {Brian I.} and Benoit Beuselinck and Lee, {Jae Lyun} and Knox, {Jennifer J.} and Bjarnason, {Georg A.} and Pal, {Sumanta Kumar} and Kollmannsberger, {Christian K.} and Takeshi Yuasa and Sandy Srinivas and Frede Donskov and Aristotelis Bamias and Wood, {Lori A.} and Ernst, {D. Scott} and Neeraj Agarwal and Vaishampayan, {Ulka N.} and Rha, {Sun Young} and Kim, {Jenny J.} and Choueiri, {Toni K.}",
year = "2014",
month = "10",
doi = "10.1016/j.eururo.2014.05.034",
language = "English",
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pages = "704--710",
journal = "European Urology",
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number = "4",

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Heng, DYC, Wells, JC, Rini, BI, Beuselinck, B, Lee, JL, Knox, JJ, Bjarnason, GA, Pal, SK, Kollmannsberger, CK, Yuasa, T, Srinivas, S, Donskov, F, Bamias, A, Wood, LA, Ernst, DS, Agarwal, N, Vaishampayan, UN, Rha, SY, Kim, JJ & Choueiri, TK 2014, 'Cytoreductive nephrectomy in patients with synchronous metastases from renal cell carcinoma: Results from the International Metastatic Renal Cell Carcinoma Database Consortium', European Urology, vol. 66, no. 4, pp. 704-710. https://doi.org/10.1016/j.eururo.2014.05.034

Cytoreductive nephrectomy in patients with synchronous metastases from renal cell carcinoma : Results from the International Metastatic Renal Cell Carcinoma Database Consortium. / Heng, Daniel Y.C.; Wells, J. Connor; Rini, Brian I.; Beuselinck, Benoit; Lee, Jae Lyun; Knox, Jennifer J.; Bjarnason, Georg A.; Pal, Sumanta Kumar; Kollmannsberger, Christian K.; Yuasa, Takeshi; Srinivas, Sandy; Donskov, Frede; Bamias, Aristotelis; Wood, Lori A.; Ernst, D. Scott; Agarwal, Neeraj; Vaishampayan, Ulka N.; Rha, Sun Young; Kim, Jenny J.; Choueiri, Toni K.

In: European Urology, Vol. 66, No. 4, 10.2014, p. 704-710.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Cytoreductive nephrectomy in patients with synchronous metastases from renal cell carcinoma

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

AU - Heng, Daniel Y.C.

AU - Wells, J. Connor

AU - Rini, Brian I.

AU - Beuselinck, Benoit

AU - Lee, Jae Lyun

AU - Knox, Jennifer J.

AU - Bjarnason, Georg A.

AU - Pal, Sumanta Kumar

AU - Kollmannsberger, Christian K.

AU - Yuasa, Takeshi

AU - Srinivas, Sandy

AU - Donskov, Frede

AU - Bamias, Aristotelis

AU - Wood, Lori A.

AU - Ernst, D. Scott

AU - Agarwal, Neeraj

AU - Vaishampayan, Ulka N.

AU - Rha, Sun Young

AU - Kim, Jenny J.

AU - Choueiri, Toni K.

PY - 2014/10

Y1 - 2014/10

N2 - Background The benefit of cytoreductive nephrectomy (CN) for overall survival (OS) is unclear in patients with synchronous metastatic renal cell carcinoma (mRCC) in the era of targeted therapy. Objective To determine OS benefit of CN compared with no CN in mRCC patients treated with targeted therapies. Design, setting, and participants Retrospective data from patients with synchronous mRCC (n = 1658) from the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) were used to compare 982 mRCC patients who had a CN with 676 mRCC patients who did not. Outcome measurements and statistical analysis OS was compared and hazard ratios (HRs) adjusted for IMDC poor prognostic criteria. Results and limitations Patients who had CN had better IMDC prognostic profiles versus those without (favorable, intermediate, or poor in 9%, 63%, and 28% vs 1%, 45%, and 54%, respectively). The median OS of patients with CN versus without CN was 20.6 versus 9.5 mo (p < 0.0001). When adjusted for IMDC criteria to correct for imbalances, the HR of death was 0.60 (95% confidence interval, 0.52-0.69; p < 0.0001). Patients estimated to survive <12 mo may receive marginal benefit from CN. Patients who have four or more of the IMDC prognostic criteria did not benefit from CN. Data were collected retrospectively. Conclusions CN is beneficial in synchronous mRCC patients treated with targeted therapy, even after adjusting for prognostic factors. Patients with estimated survival times <12 mo or four or more IMDC prognostic factors may not benefit from CN. This information may aid in patient selection as we await results from randomized controlled trials. Patient summary We looked at the survival outcomes of metastatic renal cell carcinoma patients who did or did not have the primary tumor removed. We found that most patients benefited from tumor removal, except for those with four or more IMDC risk factors.

AB - Background The benefit of cytoreductive nephrectomy (CN) for overall survival (OS) is unclear in patients with synchronous metastatic renal cell carcinoma (mRCC) in the era of targeted therapy. Objective To determine OS benefit of CN compared with no CN in mRCC patients treated with targeted therapies. Design, setting, and participants Retrospective data from patients with synchronous mRCC (n = 1658) from the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) were used to compare 982 mRCC patients who had a CN with 676 mRCC patients who did not. Outcome measurements and statistical analysis OS was compared and hazard ratios (HRs) adjusted for IMDC poor prognostic criteria. Results and limitations Patients who had CN had better IMDC prognostic profiles versus those without (favorable, intermediate, or poor in 9%, 63%, and 28% vs 1%, 45%, and 54%, respectively). The median OS of patients with CN versus without CN was 20.6 versus 9.5 mo (p < 0.0001). When adjusted for IMDC criteria to correct for imbalances, the HR of death was 0.60 (95% confidence interval, 0.52-0.69; p < 0.0001). Patients estimated to survive <12 mo may receive marginal benefit from CN. Patients who have four or more of the IMDC prognostic criteria did not benefit from CN. Data were collected retrospectively. Conclusions CN is beneficial in synchronous mRCC patients treated with targeted therapy, even after adjusting for prognostic factors. Patients with estimated survival times <12 mo or four or more IMDC prognostic factors may not benefit from CN. This information may aid in patient selection as we await results from randomized controlled trials. Patient summary We looked at the survival outcomes of metastatic renal cell carcinoma patients who did or did not have the primary tumor removed. We found that most patients benefited from tumor removal, except for those with four or more IMDC risk factors.

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U2 - 10.1016/j.eururo.2014.05.034

DO - 10.1016/j.eururo.2014.05.034

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JO - European Urology

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