Trends in cytoreductive nephrectomy in the eras of immuno and targeted therapy.

Author:

Minnillo Brian J.1,Zhu Hui2,Maurice Matthew J.3,Abouassaly Robert1

Affiliation:

1. Urological Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH

2. Case Western Reserve University/University Hospitals Urology Institute, Cleveland, OH

3. University Hospitals Case Medical Center, Cleveland, OH

Abstract

472 Background: Since the publication of randomized studies demonstrating a survival advantage in patients with metastatic renal cell carcinoma (mRCC) treated with immunotherapy, cytoreductive nephrectomy (CN) has played an integral role in the management of these patients. Our objective is to describe the use of CN in the eras of immuno and targeted therapy for mRCC. Methods: Using the National Cancer Data Base (NCDB), a joint project of the Commission on Cancer of the American College of Surgeons and the American Cancer Society, we identified patients with histologically confirmed mRCC. We examined patient, provider and disease factors associated with CN. We also assessed short-term surgical outcomes of CN. A multivariable logistic regression was used to evaluate factors associated with CN. Results: From 1998 to 2011, 30.1%(17,714) of the 58,810 patients with mRCC underwent CN (Table). Over this timeframe, there was a gradual increase in the proportion undergoing surgery (17.3% to 35.7%). In those who underwent CN, the mean length-of-stay (LOS) was 6.1 days. The 30-day readmission rate and 30-day mortality were 5.6% and 3.8%, respectively. On multivariate analysis, patients who were treated at an academic facility (OR 1.94, 95% CI 1.79-2.11, p <.0001) were more likely to be treated with CN. After adjusting for covariates, patients of African American race (OR 0.52, 95% CI 0.48-0.56, p <.0001), a tumor size of >14cm (OR 0.57, 95%CI 0.52-0.62, p<.0001), or a Charlson/Deyo score of ≥ 2 (OR 0.62, 95% CI 0.57-0.68, p < .0001) were less likely to be treated surgically. Conclusions: Cytoreductive nephrectomy for mRCC appears to be steadily increasing over time, particularly in academic medical centers, even after adjusting for potential confounders. Despite this population’s advanced disease, LOS, 30-day readmission rate and 30-day mortality are relatively low. Our results suggest that CN utilization remains high in the era of targeted therapy. [Table: see text]

Publisher

American Society of Clinical Oncology (ASCO)

Subject

Cancer Research,Oncology

Cited by 6 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3