Impact of Metastasectomy on Cancer Specific and Overall Survival in Metastatic Renal Cell Carcinoma: Analysis of the REMARCC Registry |
| |
| Affiliation: | 1. Department of Urology, UC San Diego School of Medicine, La Jolla, CA;2. Department of Urology, Fundacion Instituto Valenciano Oncologia Valencia, Spain;3. Department of Urology, Virginia Commonwealth University Medical Center, Richmond, VA;4. Department of Urology, University of Florence, Careggi Hospital, Florence, Italy;5. Department of Urology, University Medical Centre Mannheim, Mannheim, Germany;6. Department of Urology, Technical University of Munich, Munich, Germany;7. Department of Urology, University of Turin-San Luigi Gonzaga Hospital, Orbassano, Italy;8. Department of Urology, AZ Groeninge, Kortrijk, Belgium;9. Department of Urology, Hospital 12 de Octubre, Madrid, Spain;10. Department of Urology, Hospital Ramon y Cajal, Madrid, Spain;11. Department of Urology, Hospital Clinic, Carrer de Villarroel, Barcelona, Spain;12. Department of Urology, UK Leuven, Leuven, Belgium;13. Department of Urology, University of Trieste, Trieste, Italy;14. Department of Urology, Spedali Civili Hospital, University of Brescia, Brescia, Italy;15. Department of Urology, Peking University Third Hospital, Beijing, PRC;1. Department of Urology, Wake Forest University School of Medicine, Winston-Salem, NC;2. Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC;3. Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC;4. Department of Urology, University of North Carolina, Chapel Hill, NC;5. Department of Radiation Oncology, University of Kansas, Kansas City, KS;6. Atrium Health, Charlotte, NC;7. Departments of Urology and Health Policy & Management, University of California, Los Angeles, CA;8. Division of Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC;1. Department of Urology, Institut Paoli-Calmettes Cancer Center, Marseille, France;2. Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy;3. University of Milan, Milan, Italy;4. Department of Urology, CHU Yalgado Ouédraogo, Ouagadougou, Burkina Faso;5. Department of Pathology, Institut Paoli-Calmettes Cancer Center, Marseille, France;6. Department of Radiology, Institut Paoli-Calmettes Cancer Center, Marseille, France;7. Department of Urology, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milan, Italy;8. Department of Radiotherapy, Institut Paoli-Calmettes Cancer Center, Marseille, France;9. Department of Urology, IEO, European Institute of Oncology IRCCS, Milan, Italy;10. Department of Urology, Foundation IRCCS Ca'' Granda Ospedale Maggiore Policlinico, Milan, Italy;11. Department of Oncology, Institut Paoli-Calmettes Cancer Center, Marseille, France;1. Department of Urology, Kyorin University School of Medicine, Tokyo, Japan;2. Department of Radiology, Kyorin University School of Medicine, Tokyo, Japan;3. Department of Radiology, Tokyo Women''s Medical University Medical Center East, Tokyo, Japan;1. Department of Urology and Pediatric Urology, University Hospital of Würzburg, Würzburg, Germany;2. Department of Urology, University Hospital of Tübingen, Tübingen, Germany;3. King Salman Hospital (MOH), Riyadh, Saudi Arabia;1. Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan;2. Department of Urology, Dokkyo Medical University Saitama Medical Center, Saitama, Japan;3. Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA;4. Department of Urology, University of California San Diego, San Diego, California, USA;1. Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China;2. Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China |
| |
| Abstract: | BackgroundTreatment paradigms for management of metastatic renal cell carcinoma (mRCC) are evolving. We examined impact of surgical metastasectomy on survival across in mRCC stratified by risk-group.MethodsMulticenter retrospective analysis from the Registry of Metastatic RCC database. The cohort was subdivided utilizing Motzer criteria (favorable-, intermediate-, high-risk). Primary outcome was all-cause mortality (ACM)/overall survival (OS); secondary outcome was cancer-specific mortality (CSM)/cancer-specific survival (CSS). Impact of metastasectomy was analyzed via Cox-Regression analysis adjusting for potential prognostic variables and Kaplan-Meier analysis (KMA) within each risk-group.ResultsFour hundred thirty-one patients (59 favorable-risk, 274 intermediate-risk, 98 high-risk; median follow-up 27.2 months) were analyzed. Metastasectomy was performed in 22 (37%), 66 (24%), and 32 (16%) of favorable-, intermediate- and high-risk groups (P = .012). Median number of metastases at diagnosis differed significantly (favorable-risk 2, intermediate-risk 3.4, high-risk 5.1, P < .001). On Cox-regression, high-risk (HR = 1.72, P = .002) was associated with worsened ACM, while metastasectomy was associated with improved ACM (HR = 0.56, P = .005). On KMA, median OS (months) was longer with metastasectomy in favorable- (92.7 vs. 25.8, P = .003) and intermediate-risk (26.3 vs. 20.1, P = .038), but not high-risk (P = .911) groups. Metastasectomy was associated with longer CSS in favorable- (76.1 vs. 32.8, P = .004) but not intermediate- (P = .06) and high-risk (P = .595) groups.ConclusionsMetastasectomy was independently associated with improved ACM and CSM, as well as improved CSS and OS in favorable- and intermediate-risk mRCC patients. Metastasectomy may be considered as component of multimodal management strategy in favorable and intermediate-risk subgroups. In high-risk patients, metastasectomy should be deferred except in select circumstances. |
| |
| Keywords: | Motzer |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
