Deferred Cytoreductive Nephrectomy in Patients with Newly Diagnosed Metastatic Renal Cell Carcinoma

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Deferred Cytoreductive Nephrectomy in Patients with Newly Diagnosed Metastatic Renal Cell Carcinoma. / Bhindi, Bimal; Graham, Jeffrey; Wells, J Connor; Bakouny, Ziad; Donskov, Frede; Fraccon, Anna; Pasini, Felice; Lee, Jae Lyun; Basappa, Naveen S; Hansen, Aaron; Kollmannsberger, Christian K; Kanesvaran, Ravindran; Yuasa, Takeshi; Ernst, D Scott; Srinivas, Sandy; Rini, Brian I; Bowman, Isaac; Pal, Sumanta K; Choueiri, Toni K; Heng, Daniel Y C.

I: European Urology, Bind 78, Nr. 4, 2020, s. 615-623.

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avisTidsskriftartikelForskningpeer review

Harvard

Bhindi, B, Graham, J, Wells, JC, Bakouny, Z, Donskov, F, Fraccon, A, Pasini, F, Lee, JL, Basappa, NS, Hansen, A, Kollmannsberger, CK, Kanesvaran, R, Yuasa, T, Ernst, DS, Srinivas, S, Rini, BI, Bowman, I, Pal, SK, Choueiri, TK & Heng, DYC 2020, 'Deferred Cytoreductive Nephrectomy in Patients with Newly Diagnosed Metastatic Renal Cell Carcinoma', European Urology, bind 78, nr. 4, s. 615-623. https://doi.org/10.1016/j.eururo.2020.04.038

APA

Bhindi, B., Graham, J., Wells, J. C., Bakouny, Z., Donskov, F., Fraccon, A., Pasini, F., Lee, J. L., Basappa, N. S., Hansen, A., Kollmannsberger, C. K., Kanesvaran, R., Yuasa, T., Ernst, D. S., Srinivas, S., Rini, B. I., Bowman, I., Pal, S. K., Choueiri, T. K., & Heng, D. Y. C. (2020). Deferred Cytoreductive Nephrectomy in Patients with Newly Diagnosed Metastatic Renal Cell Carcinoma. European Urology, 78(4), 615-623. https://doi.org/10.1016/j.eururo.2020.04.038

CBE

Bhindi B, Graham J, Wells JC, Bakouny Z, Donskov F, Fraccon A, Pasini F, Lee JL, Basappa NS, Hansen A, Kollmannsberger CK, Kanesvaran R, Yuasa T, Ernst DS, Srinivas S, Rini BI, Bowman I, Pal SK, Choueiri TK, Heng DYC. 2020. Deferred Cytoreductive Nephrectomy in Patients with Newly Diagnosed Metastatic Renal Cell Carcinoma. European Urology. 78(4):615-623. https://doi.org/10.1016/j.eururo.2020.04.038

MLA

Vancouver

Author

Bhindi, Bimal ; Graham, Jeffrey ; Wells, J Connor ; Bakouny, Ziad ; Donskov, Frede ; Fraccon, Anna ; Pasini, Felice ; Lee, Jae Lyun ; Basappa, Naveen S ; Hansen, Aaron ; Kollmannsberger, Christian K ; Kanesvaran, Ravindran ; Yuasa, Takeshi ; Ernst, D Scott ; Srinivas, Sandy ; Rini, Brian I ; Bowman, Isaac ; Pal, Sumanta K ; Choueiri, Toni K ; Heng, Daniel Y C. / Deferred Cytoreductive Nephrectomy in Patients with Newly Diagnosed Metastatic Renal Cell Carcinoma. I: European Urology. 2020 ; Bind 78, Nr. 4. s. 615-623.

Bibtex

@article{13645344f3c746d3987ca0c48f323822,
title = "Deferred Cytoreductive Nephrectomy in Patients with Newly Diagnosed Metastatic Renal Cell Carcinoma",
abstract = "BACKGROUND: The use of cytoreductive nephrectomy (CN) selectively for patients who show a favorable response to upfront systemic therapy may be an approach to select optimal candidates with metastatic renal cell carcinoma (mRCC) who are most likely to benefit.OBJECTIVE: We sought to characterize outcomes of deferred CN (dCN) after upfront sunitinib, outcomes relative to sunitinib alone, and outcomes of CN followed by sunitinib.DESIGN, SETTING, AND PARTICIPANTS: We used the prospectively maintained International mRCC Database Consortium (IMDC) database to identify patients with newly diagnosed mRCC (2006-2018).INTERVENTION: Sunitinib alone, upfront CN followed by sunitinib, sunitinib followed by dCN.OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Outcomes were overall survival (OS) and time to sunitinib treatment failure (TTF). Kaplan-Meier and multivariable Cox regression analyses were performed; dCN was analyzed as a time-varying covariate to account for immortal time bias.RESULTS AND LIMITATIONS: We evaluated 1541 patients, of whom 651 (42%) received sunitinib alone, 805 (52%) underwent CN followed by sunitinib, and 85 (5.5%) received sunitinib followed by dCN, at a median of 7.8 mo from diagnosis. Median OS periods for patients treated with sunitinib alone, CN followed by sunitinib, and sunitinib followed by dCN were 10, 19, and 46 mo, respectively, while the median TTF values were 4, 8, and 13 mo, respectively. In multivariable regression analyses, sunitinib followed by dCN was significantly associated with improved OS (hazard ratio [HR] = 0.45, 95% confidence interval [CI] 0.33-0.60, p < 0.001) and TTF (HR = 0.62, 95% CI 0.46-0.85, p = 0.003) versus sunitinib alone. Among CN-treated patients, sunitinib followed by dCN was associated with improved OS (HR = 0.52, 95% CI 0.39-0.70, p < 0.001) and TTF (HR = 0.71, 95% CI 0.56-0.90, p = 0.005) compared with upfront CN followed by sunitinib. In various sensitivity analyses, dCN remained significantly associated with improved OS and TTF.CONCLUSIONS: Patients who received dCN were carefully selected and achieved long OS. With these benchmark outcomes, optimal selection criteria need to be identified and confirmation of the role of dCN in a clinical trial is warranted.PATIENT SUMMARY: We characterized benchmark survival outcomes for patients with metastatic kidney cancer treated with sunitinib alone, nephrectomy (kidney removal) followed by sunitinib, and sunitinib followed by nephrectomy. Patients who had their nephrectomy after an initial course of sunitinib had prolonged survival.",
keywords = "Cytoreduction surgical procedures, Neoplasm metastasis, Nephrectomy, Renal cell carcinoma, Targeted therapy, Tyrosine kinase inhibitor",
author = "Bimal Bhindi and Jeffrey Graham and Wells, {J Connor} and Ziad Bakouny and Frede Donskov and Anna Fraccon and Felice Pasini and Lee, {Jae Lyun} and Basappa, {Naveen S} and Aaron Hansen and Kollmannsberger, {Christian K} and Ravindran Kanesvaran and Takeshi Yuasa and Ernst, {D Scott} and Sandy Srinivas and Rini, {Brian I} and Isaac Bowman and Pal, {Sumanta K} and Choueiri, {Toni K} and Heng, {Daniel Y C}",
note = "Copyright {\textcopyright} 2020. Published by Elsevier B.V.",
year = "2020",
doi = "10.1016/j.eururo.2020.04.038",
language = "English",
volume = "78",
pages = "615--623",
journal = "European Urology (Italian Edition)",
issn = "1828-6569",
publisher = "EdizioniEdra",
number = "4",

}

RIS

TY - JOUR

T1 - Deferred Cytoreductive Nephrectomy in Patients with Newly Diagnosed Metastatic Renal Cell Carcinoma

AU - Bhindi, Bimal

AU - Graham, Jeffrey

AU - Wells, J Connor

AU - Bakouny, Ziad

AU - Donskov, Frede

AU - Fraccon, Anna

AU - Pasini, Felice

AU - Lee, Jae Lyun

AU - Basappa, Naveen S

AU - Hansen, Aaron

AU - Kollmannsberger, Christian K

AU - Kanesvaran, Ravindran

AU - Yuasa, Takeshi

AU - Ernst, D Scott

AU - Srinivas, Sandy

AU - Rini, Brian I

AU - Bowman, Isaac

AU - Pal, Sumanta K

AU - Choueiri, Toni K

AU - Heng, Daniel Y C

N1 - Copyright © 2020. Published by Elsevier B.V.

PY - 2020

Y1 - 2020

N2 - BACKGROUND: The use of cytoreductive nephrectomy (CN) selectively for patients who show a favorable response to upfront systemic therapy may be an approach to select optimal candidates with metastatic renal cell carcinoma (mRCC) who are most likely to benefit.OBJECTIVE: We sought to characterize outcomes of deferred CN (dCN) after upfront sunitinib, outcomes relative to sunitinib alone, and outcomes of CN followed by sunitinib.DESIGN, SETTING, AND PARTICIPANTS: We used the prospectively maintained International mRCC Database Consortium (IMDC) database to identify patients with newly diagnosed mRCC (2006-2018).INTERVENTION: Sunitinib alone, upfront CN followed by sunitinib, sunitinib followed by dCN.OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Outcomes were overall survival (OS) and time to sunitinib treatment failure (TTF). Kaplan-Meier and multivariable Cox regression analyses were performed; dCN was analyzed as a time-varying covariate to account for immortal time bias.RESULTS AND LIMITATIONS: We evaluated 1541 patients, of whom 651 (42%) received sunitinib alone, 805 (52%) underwent CN followed by sunitinib, and 85 (5.5%) received sunitinib followed by dCN, at a median of 7.8 mo from diagnosis. Median OS periods for patients treated with sunitinib alone, CN followed by sunitinib, and sunitinib followed by dCN were 10, 19, and 46 mo, respectively, while the median TTF values were 4, 8, and 13 mo, respectively. In multivariable regression analyses, sunitinib followed by dCN was significantly associated with improved OS (hazard ratio [HR] = 0.45, 95% confidence interval [CI] 0.33-0.60, p < 0.001) and TTF (HR = 0.62, 95% CI 0.46-0.85, p = 0.003) versus sunitinib alone. Among CN-treated patients, sunitinib followed by dCN was associated with improved OS (HR = 0.52, 95% CI 0.39-0.70, p < 0.001) and TTF (HR = 0.71, 95% CI 0.56-0.90, p = 0.005) compared with upfront CN followed by sunitinib. In various sensitivity analyses, dCN remained significantly associated with improved OS and TTF.CONCLUSIONS: Patients who received dCN were carefully selected and achieved long OS. With these benchmark outcomes, optimal selection criteria need to be identified and confirmation of the role of dCN in a clinical trial is warranted.PATIENT SUMMARY: We characterized benchmark survival outcomes for patients with metastatic kidney cancer treated with sunitinib alone, nephrectomy (kidney removal) followed by sunitinib, and sunitinib followed by nephrectomy. Patients who had their nephrectomy after an initial course of sunitinib had prolonged survival.

AB - BACKGROUND: The use of cytoreductive nephrectomy (CN) selectively for patients who show a favorable response to upfront systemic therapy may be an approach to select optimal candidates with metastatic renal cell carcinoma (mRCC) who are most likely to benefit.OBJECTIVE: We sought to characterize outcomes of deferred CN (dCN) after upfront sunitinib, outcomes relative to sunitinib alone, and outcomes of CN followed by sunitinib.DESIGN, SETTING, AND PARTICIPANTS: We used the prospectively maintained International mRCC Database Consortium (IMDC) database to identify patients with newly diagnosed mRCC (2006-2018).INTERVENTION: Sunitinib alone, upfront CN followed by sunitinib, sunitinib followed by dCN.OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Outcomes were overall survival (OS) and time to sunitinib treatment failure (TTF). Kaplan-Meier and multivariable Cox regression analyses were performed; dCN was analyzed as a time-varying covariate to account for immortal time bias.RESULTS AND LIMITATIONS: We evaluated 1541 patients, of whom 651 (42%) received sunitinib alone, 805 (52%) underwent CN followed by sunitinib, and 85 (5.5%) received sunitinib followed by dCN, at a median of 7.8 mo from diagnosis. Median OS periods for patients treated with sunitinib alone, CN followed by sunitinib, and sunitinib followed by dCN were 10, 19, and 46 mo, respectively, while the median TTF values were 4, 8, and 13 mo, respectively. In multivariable regression analyses, sunitinib followed by dCN was significantly associated with improved OS (hazard ratio [HR] = 0.45, 95% confidence interval [CI] 0.33-0.60, p < 0.001) and TTF (HR = 0.62, 95% CI 0.46-0.85, p = 0.003) versus sunitinib alone. Among CN-treated patients, sunitinib followed by dCN was associated with improved OS (HR = 0.52, 95% CI 0.39-0.70, p < 0.001) and TTF (HR = 0.71, 95% CI 0.56-0.90, p = 0.005) compared with upfront CN followed by sunitinib. In various sensitivity analyses, dCN remained significantly associated with improved OS and TTF.CONCLUSIONS: Patients who received dCN were carefully selected and achieved long OS. With these benchmark outcomes, optimal selection criteria need to be identified and confirmation of the role of dCN in a clinical trial is warranted.PATIENT SUMMARY: We characterized benchmark survival outcomes for patients with metastatic kidney cancer treated with sunitinib alone, nephrectomy (kidney removal) followed by sunitinib, and sunitinib followed by nephrectomy. Patients who had their nephrectomy after an initial course of sunitinib had prolonged survival.

KW - Cytoreduction surgical procedures

KW - Neoplasm metastasis

KW - Nephrectomy

KW - Renal cell carcinoma

KW - Targeted therapy

KW - Tyrosine kinase inhibitor

UR - http://www.scopus.com/inward/record.url?scp=85084120513&partnerID=8YFLogxK

U2 - 10.1016/j.eururo.2020.04.038

DO - 10.1016/j.eururo.2020.04.038

M3 - Journal article

C2 - 32362493

VL - 78

SP - 615

EP - 623

JO - European Urology (Italian Edition)

JF - European Urology (Italian Edition)

SN - 1828-6569

IS - 4

ER -