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.
N1 - Publisher Copyright:
© 2023 European Association of Urology
PY - 2023/9
Y1 - 2023/9
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 naïve, 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 (Δ = 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 naïve, 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 naïve, 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 (Δ = 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 naïve, 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
UR - https://www.scopus.com/pages/publications/85150029029
U2 - 10.1016/j.euf.2023.02.010
DO - 10.1016/j.euf.2023.02.010
M3 - Article
SN - 2405-4569
VL - 9
SP - 742
EP - 750
JO - European Urology Focus
JF - European Urology Focus
IS - 5
ER -