TY - JOUR
T1 - The Association Between Cytoreductive Nephrectomy and Overall Survival in Metastatic Renal Cell Carcinoma with Primary Tumor Size ≤4 cm
AU - Tappero, Stefano
AU - Barletta, Francesco
AU - Piccinelli, Mattia Luca
AU - Cano Garcia, Cristina
AU - Incesu, Reha-Baris
AU - Morra, Simone
AU - Scheipner, Lukas
AU - Tian, Zhe
AU - Parodi, Stefano
AU - Dell'Oglio, Paolo
AU - PALUMBO, CARLOTTA
AU - Briganti, Alberto
AU - De Cobelli, Ottavio
AU - Chun, Felix K H
AU - Graefen, Markus
AU - Longo, Nicola
AU - Ahyai, Sascha
AU - Saad, Fred
AU - Shariat, Shahrokh F
AU - Suardi, Nazareno
AU - Borghesi, Marco
AU - Terrone, Carlo
AU - Karakiewicz, Pierre I
PY - 2023
Y1 - 2023
N2 - Background It is unknown whether the survival benefit of cytoreductive nephrectomy (CN) in metastatic renal cell carcinoma (mRCC) applies to patients with primary tumor size <= 4 cm.Objective To test the association between CN on overall survival (OS) of mRCC patients with primary tumor size <= 4 cm.Design, setting, and participants Within the Surveillance, Epidemiology, and End Results (SEER) database (2006-2018), all mRCC patients with primary tumor size <= 4 cm were identified.Outcome measurements and statistical analysis Propensity score matching (PSM), Kaplan-Meier plots, multivariable Cox regression analyses, and 6-mo landmark analyses addressed OS according to CN status. Sensitivity analyses examined specific populations of special interest: systemic therapy exposed versus na & iuml;ve, clear-cell (ccmRCC) versus non-clear-cell (non-ccmRCC) mRCC histology, historical (2006-2012) versus contemporary (2013-2018), and young (<= 65 yr) versus old (>65 yr) patients.Results and limitations Of 814 patients, 387 (48%) underwent CN. After PSM, the median OS was 44 versus 7 mo (Delta = 37 mo; p < 0.001) in CN versus no-CN patients. CN was associated with higher OS in overall population (multivariable hazard ratio [HR]: 0.30; p < 0.001) as well as in landmark analyses (HR: 0.39; p < 0.001). In all sensitivity analyses, CN was independently associated with higher OS: systemic therapy exposed, HR: 0.38; systemic therapy na & iuml;ve, HR: 0.31; ccmRCC, HR: 0.29; non-ccmRCC, HR: 0.37; historical, HR: 0.31; contemporary, HR: 0.30; young, HR: 0.23; and old, HR: 0.39 (all p < 0.001).Conclusions The current study validates the association between CN and higher OS in patients with primary tumor size <= 4 cm. This association is robust, controlled for immortal time bias, and valid across systemic treatment exposure, histologic subtypes, years of surgery, and patient age.Patient summary In the current study, we tested the association between cytoreductive nephrectomy (CN) and overall survival in patients with metastatic renal cell carcinoma and small primary tumor size. We found a strong association between CN and survival, which persists even after several significant variations in patient and tumor characteristics.
AB - Background It is unknown whether the survival benefit of cytoreductive nephrectomy (CN) in metastatic renal cell carcinoma (mRCC) applies to patients with primary tumor size <= 4 cm.Objective To test the association between CN on overall survival (OS) of mRCC patients with primary tumor size <= 4 cm.Design, setting, and participants Within the Surveillance, Epidemiology, and End Results (SEER) database (2006-2018), all mRCC patients with primary tumor size <= 4 cm were identified.Outcome measurements and statistical analysis Propensity score matching (PSM), Kaplan-Meier plots, multivariable Cox regression analyses, and 6-mo landmark analyses addressed OS according to CN status. Sensitivity analyses examined specific populations of special interest: systemic therapy exposed versus na & iuml;ve, clear-cell (ccmRCC) versus non-clear-cell (non-ccmRCC) mRCC histology, historical (2006-2012) versus contemporary (2013-2018), and young (<= 65 yr) versus old (>65 yr) patients.Results and limitations Of 814 patients, 387 (48%) underwent CN. After PSM, the median OS was 44 versus 7 mo (Delta = 37 mo; p < 0.001) in CN versus no-CN patients. CN was associated with higher OS in overall population (multivariable hazard ratio [HR]: 0.30; p < 0.001) as well as in landmark analyses (HR: 0.39; p < 0.001). In all sensitivity analyses, CN was independently associated with higher OS: systemic therapy exposed, HR: 0.38; systemic therapy na & iuml;ve, HR: 0.31; ccmRCC, HR: 0.29; non-ccmRCC, HR: 0.37; historical, HR: 0.31; contemporary, HR: 0.30; young, HR: 0.23; and old, HR: 0.39 (all p < 0.001).Conclusions The current study validates the association between CN and higher OS in patients with primary tumor size <= 4 cm. This association is robust, controlled for immortal time bias, and valid across systemic treatment exposure, histologic subtypes, years of surgery, and patient age.Patient summary In the current study, we tested the association between cytoreductive nephrectomy (CN) and overall survival in patients with metastatic renal cell carcinoma and small primary tumor size. We found a strong association between CN and survival, which persists even after several significant variations in patient and tumor characteristics.
KW - Cytoreductive nephrectomy
KW - Metastatic renal cell carcinoma
KW - Tumor size
KW - Cytoreductive nephrectomy
KW - Metastatic renal cell carcinoma
KW - Tumor size
UR - https://iris.uniupo.it/handle/11579/182742
U2 - 10.1016/j.euf.2023.02.010
DO - 10.1016/j.euf.2023.02.010
M3 - Article
SN - 2405-4569
VL - 9
JO - European Urology Focus
JF - European Urology Focus
IS - 5
ER -