To evaluate the effect of cytoreductive nephrectomy (CN) on overall survival (OS) in primary metastatic renal cell carcinoma (mRCC) patients treated with first-line sunitinib.
Patients with primary mRCC treated with first-line sunitinib were selected from a Dutch population-based registry. A propensity score was calculated reflecting the probability of a patient undergoing CN prior to sunitinib using a set of known covariates, such as the MSKCC and IMDC risk factors. After propensity score matching, differences in OS were analysed using the Kaplan-Meier method and a multivariable Cox proportional hazards model was used to evaluate the effect of CN on OS.
227 patients met the selection criteria; 74 patients (33%) underwent CN prior to sunitinib. In the matched population, median OS of patients who underwent CN was 17.9 months compared to 8.8 months for patients treated with sunitinib only. Multivariable analysis showed that CN was an independent predictor of OS (HR 0.61; 95%CI: 0.41-0.92). A subgroup analysis of patients with a time to targeted therapy <1 year showed a median OS of 12.7 months for patients treated with CN compared to 8.0 months for patients treated with sunitinib only. The corresponding HR was 0.67 (95%CI: 0.46-0.98).
This study suggests that CN may be effective. However, the benefit was modest when correcting for time from diagnosis to sunitinib. One important limitation is the use of a registry (with retrospectively collected data), which made it impossible to correct for unmeasured characteristics that could be associated with treatment choices or survival.
Urology. 2016 May 11 [Epub ahead of print]
S de Groot, W K Redekop, S Sleijfer, E Oosterwijk, A Bex, L A L M Kiemeney, C A Uyl-de Groot
Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands. Electronic address: ., Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands., Department of Medical Oncology, Erasmus MC Cancer Institute and Cancer Genomics Netherlands, Rotterdam, The Netherlands., Department of Urology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands., Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands., Department of Urology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands; Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands., Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.