OBJECTIVES: To determine whether patients with metastatic non-clear cell renal cell carcinoma (RCC) benefit from cytoreductive nephrectomy (CN).
PATIENTS AND METHODS: We used the Surveillance, Epidemiology, and End Results Program to identify a population-based sample of 4914 patients diagnosed with metastatic RCC between 2000-2009. Of these, 591 patients had non-clear cell histology. The median follow up was 20 months. The primary outcome measure was RCC-specific mortality.
RESULTS: Approximately 64% of patients underwent CN. Patients with non-clear cell histology who underwent CN displayed lower RCC-specific and all-cause mortality than those who did not (p< .001 in both cases). After adjustment for age, gender, race, marital status, year of diagnosis, geographic location, and histology the associations between CN and decreased RCC-specific mortality (HR 0.62, 95% CI 0.48-0.80, p< .001) and CN and all-cause mortality (HR 0.45, 95% CI 0.37-0.55, p< .001) remained highly significant. Among patients diagnosed in 2006-2009 (targeted therapy era), the results remained unchanged (HR 0.50, 95% CI 0.34-0.72, p< .001 and HR 0.43, 95% CI 0.31-0.59, p< .001, respectively). An interaction model revealed that all histologies displayed decreased all-cause mortality with CN.
CONCLUSION: Patients with metastatic non-clear cell RCC from the SEER program, including those treated in the targeted therapy era, appear to derive a survival benefit from CN, an association which remained significant regardless of histologic subtype. This observation suggests that CN remains standard in advanced RCC patients deemed to be surgical candidates.
Written by:
Aizer AA, Urun Y, McKay RR, Kibel AS, Nguyen PL, Choueiri TK. Are you the author?
Harvard Radiation Oncology Program, Boston, MA, United States.
Reference: BJU Int. 2013 Sep 5. Epub ahead of print.
doi: 10.1111/bju.12442
PubMed Abstract
PMID: 24053727
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