TY - JOUR
T1 - Predictors, utilization patterns, and overall survival of patients undergoing metastasectomy for metastatic renal cell carcinoma in the era of targeted therapy
AU - Sun, Maxine
AU - Meyer, Christian P.
AU - Karam, Jose A.
AU - de Velasco, Guillermo
AU - Chang, Steven L.
AU - Pal, Sumanta K.
AU - Trinh, Quoc Dien
AU - Choueiri, Toni K.
N1 - Publisher Copyright:
© 2018 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology
PY - 2018/9
Y1 - 2018/9
N2 - Introduction: Metastasectomy (MSX) is considered a treatment option in patients with metastatic renal cell carcinoma (mRCC) at diagnosis, but its role in the targeted therapy era is unclear. We sought to describe the utilization trends of MSX and survival outcomes in a large US cohort. Materials and methods: Using the National Cancer Database, we identified patients undergoing MSX for mRCC at diagnosis between 2006 and 2013. Linear regression methods estimated utilization trends, and hierarchical models identified independent predictors of MSX after adjusting for hospital clustering. Kaplan-Meier survival estimates and Cox proportional hazard models were used to evaluate overall survival according to treatment after propensity-score matching. Results: Of 6994 mRCC patients, 1976 underwent MSX (28.3%). Those treated at academic facilities were more likely to undergo a MSX (OR: 1.57, 95% CI 1.20–2.06, p = 0.001). In contrast, older patients (OR: 0.99, 95% CI: 0.98–1.00), black race (OR: 0.65, 95% CI: 0.51–0.82), higher pT stage (OR: 0.76, 95% CI: 0.65–0.89), and who received targeted therapy (OR: 0.72, 95% CI: 0.63–0.82, all p ≤ 0.008) were less likely to undergo MSX. Overall, MSX patients had an improved survival compared to non-MSX patients (HR: 0.83, 95% CI: 0.77–0.90, p < 0.001), as well as among patients treated with targeted therapy (HR: 0.77, 95% CI: 0.77–0.96, p = 0.008). Conclusions: Our findings indicate that MSX-treated patients may benefit from an improved overall survival compared to non-MSX treated patients. Good patient selection and a proper risk stratification strategy are still very important considerations.
AB - Introduction: Metastasectomy (MSX) is considered a treatment option in patients with metastatic renal cell carcinoma (mRCC) at diagnosis, but its role in the targeted therapy era is unclear. We sought to describe the utilization trends of MSX and survival outcomes in a large US cohort. Materials and methods: Using the National Cancer Database, we identified patients undergoing MSX for mRCC at diagnosis between 2006 and 2013. Linear regression methods estimated utilization trends, and hierarchical models identified independent predictors of MSX after adjusting for hospital clustering. Kaplan-Meier survival estimates and Cox proportional hazard models were used to evaluate overall survival according to treatment after propensity-score matching. Results: Of 6994 mRCC patients, 1976 underwent MSX (28.3%). Those treated at academic facilities were more likely to undergo a MSX (OR: 1.57, 95% CI 1.20–2.06, p = 0.001). In contrast, older patients (OR: 0.99, 95% CI: 0.98–1.00), black race (OR: 0.65, 95% CI: 0.51–0.82), higher pT stage (OR: 0.76, 95% CI: 0.65–0.89), and who received targeted therapy (OR: 0.72, 95% CI: 0.63–0.82, all p ≤ 0.008) were less likely to undergo MSX. Overall, MSX patients had an improved survival compared to non-MSX patients (HR: 0.83, 95% CI: 0.77–0.90, p < 0.001), as well as among patients treated with targeted therapy (HR: 0.77, 95% CI: 0.77–0.96, p = 0.008). Conclusions: Our findings indicate that MSX-treated patients may benefit from an improved overall survival compared to non-MSX treated patients. Good patient selection and a proper risk stratification strategy are still very important considerations.
KW - Metastasectomy
KW - Metastasis
KW - NCDB
KW - Renal cell carcinoma
KW - Targeted therapy
UR - http://www.scopus.com/inward/record.url?scp=85048831314&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85048831314&partnerID=8YFLogxK
U2 - 10.1016/j.ejso.2018.05.026
DO - 10.1016/j.ejso.2018.05.026
M3 - Article
C2 - 29935840
AN - SCOPUS:85048831314
SN - 0748-7983
VL - 44
SP - 1439
EP - 1445
JO - European Journal of Surgical Oncology
JF - European Journal of Surgical Oncology
IS - 9
ER -