Treatment facility volume and survival in patients with metastatic renal cell carcinoma.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 594-594 ◽  
Author(s):  
Daniel M. Geynisman ◽  
Elizabeth Handorf ◽  
Matthew R. Zibelman ◽  
Elizabeth R. Plimack ◽  
Robert Uzzo ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Overall Survival ◽  
Cell Carcinoma ◽  
Metastatic Renal Cell Carcinoma ◽  
Systemic Therapy ◽  
Renal Cell ◽  
High Volume ◽  
Inclusion Criteria ◽  
Treatment Facility ◽  
Cancer Data

594 Background: Higher treatment facility (TF) volume has been linked with improved surgical and hematologic malignancy outcomes. We evaluated the association between TF volume and overall survival (OS) in pts with metastatic renal cell carcinoma (mRCC). Methods: The National Cancer Data Base was queried for all pts with mRCC and survival data available (2004 to 2013, cohort A). We defined high volume TFs as those in the top 20th percentile of mean number of mRCC pts treated per year ( > 5 pts). The effect of volume on OS was determined using unadjusted Kaplan-Meier curves and Cox regression models (MVA) adjusting for pt (age, sex, race, ethnicity, insurance type, income, Charlson-Deyo Score), facility (location, practice setting) and clinical characteristics (histology, presence or absence of liver and lung metastasis). Increasingly more stringent inclusion criteria were used to confirm the overall cohort association (cohort B = mRCC pts with active treatment; cohort C = mRCC pts with systemic therapy; cohort D = mRCC pts with systemic therapy at the reporting institution; cohort E = mRCC pts with systemic therapy at the reporting institution with liver and lung metastatic status known). Results: There were 44,109 mRCC pts treated at 1,224 TFs. The median age was 65, 66% were men and 75% had clear cell mRCC. Median TF volume was 2.4 pts/year (range 0.1-46.8). High volume TFs treated 54% of all mRCC pts. The unadjusted median overall survival of mRCC patients (cohort A) treated at high vs low volume TFs was 9.2 vs 6.4 months (P < 0.0001). This difference was maintained in all cohorts: cohort B = 13.7 vs 10.9, cohort C = 12.4 vs 10.0, cohort D = 12.5 vs 9.3, and cohort E = 13.4 vs 10.6 months (P < 0.0001 for all cohorts). MVA confirmed that facility volume was associated with all-cause mortality after adjustment: HR = 0.85, [95% CI 0.82-0.88], P < 0.001. These results were consistent regardless of inclusion criteria, e.g. for cohort E: HR = 0.839, [95% CI 0.785-0.897], P < 0.0001. Considering the definition of high volume, all thresholds > 5 pts/year showed a survival benefit, with the largest effects at ≥10 pts/year. Conclusions: Patients with mRCC treated at higher volume facilities had a longer survival compared with those treated at lower volume facilities.

Prognostic value of simple blood biomarkers of systemic inflammation for metastatic renal cell carcinoma (mRCC) patients who undergo cytoreductive nephrectomy (CNx).

2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 350-350
Author(s):  
Jigi Moudgil-Joshi ◽  
Mark Stares ◽  
Alex Laird ◽  
Steve Leung ◽  
Jahangeer Malik ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Overall Survival ◽  
Multivariate Analysis ◽  
Inflammatory Response ◽  
Cell Carcinoma ◽  
Metastatic Renal Cell Carcinoma ◽  
Systemic Therapy ◽  
Renal Cell ◽  
Cytoreductive Nephrectomy

350 Background: The role of cytoreductive nephrectomy (CNx) in patients with metastatic renal cell carcinoma (mRCC) is currently in question. Assessing the benefits and risks of CNx is challenging, with a lack of validated prognostic tools. Biomarkers of the systemic inflammatory response have prognostic utility in mRCC and are included in the IMDC score used to predict survival in patients with mRCC treated with systemic therapy. We sought to investigate their role in patients with mRCC who had undergone CNx. Methods: A cohort of 68 patients, suitable for first-line VEGFR inhibitor (VEGFRi) systemic therapy, who had undergone CNx for mRCC, were identified from a clinical database of patients referred to a regional mRCC service. Inflammatory biomarkers from routine blood tests (haemoglobin, white cell count, neutrophil count, platelets, C-reactive protein (CRP), albumin) and the IMDC score, measured at the time of diagnosis of mRCC, were recorded. The relationship between these and overall survival and time to VEGFRi (tVEGFRi) was examined using Kaplan-Meier and Cox-regression methods. Results: Data were available for 68 patients. Median survival was 33.7 months. On multivariate analysis, albumin ( < 35g g/dL v ≥35 g/dL) and CRP (≤ 10 mg/L v > 10 mg/L) were independently associated with overall survival (p = 0.027 and p = 0.034 respectively). Albumin stratified survival from 24.7 to 87.2 months (p < 0.0001) and CRP from 29.4 to 82.3 months (p = 0.004). 40 (59%) patients subsequently commenced VEGFRi therapy. Median tVEGFRi was 18.1 months, with only 5 (7%) patients commencing treatment within 3 months. 16 (24%) patients yet to receive systemic therapy remain alive after a median 54.0 months follow-up. On multivariate analysis, albumin was also predictive of tVEGFRi (p = 0.037), stratifying tVEGFRi from 6.07 to 45.7 months (p = 0.002). Conclusions: These results highlight that biomarkers of the systemic inflammatory response are strong prognostic factors in mRCC patients who have undergone CNx. Albumin and CRP, but not IMDC, predict survival in this patient group. Significantly, the population investigated here differ from those included in the CARMENA and SURTIME studies, with a majority undergoing surveillance prior to VEGFRi therapy. Our results support a role for CNx in patients where deferred systemic therapy strategies may be employed. Albumin may assist in clinical decision making when considering when to start systemic therapy. We advocate further studies to investigate the prognostic role of these simple, routine clinical tests in patients with mRCC undergoing CNx.

Impact of precise quantitative assessment of visceral obesity on outcomes of patients with metastatic renal cell carcinoma treated with systemic therapy.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 597-597
Author(s):  
Ryuichi Mizuno ◽  
Akira Miyajima ◽  
Nozomi Hayakawa ◽  
Eiji Kikuchi ◽  
Shuji Mikami ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Overall Survival ◽  
Cell Carcinoma ◽  
Metastatic Renal Cell Carcinoma ◽  
Systemic Therapy ◽  
Visceral Fat ◽  
Renal Cell ◽  
Visceral Obesity ◽  
Cancer Center ◽  
Visceral Fat Area

597 Background: With its excellent resolution of adipose tissue, CT presents precise quantitative assessment of visceral obesity. We assessed the impact of visceral obesity on progression free and overall survival in patients treated with systemic therapy for metastatic renal cell carcinoma. Methods: This retrospective cohort study included 114 patients treated with systemic therapy for metastatic renal cell carcinoma between 2007 and 2015 at Keio university hospital in Japan. The visceral fat area was measured at the level of umbilicus using CT. A visceral fat area ≥100cm2 was used as the definition of visceral obesity. Progression free and overall survival was compared according to visceral obesity. Results: In the whole cohort, the median progression free survival in first line treatment was 12.0 month. The median overall survival was 42.5 month. According to Memorial Sloan-Kettering Cancer Center classification, 31 patients were favorable risk, 61 were intermediate risk, and 22 were poor risk; median overall survival for these groups were 76.9, 40.8, and 23.7 months, respectively (P<0.0001). Visceral obesity correlated with improved progression free (P=0.0095) and overall survival (P=0.0002). On multivariate analysis, visceral obesity (HR 0.64, P=0.0393) and Memorial Sloan-Kettering Cancer Center classification (P=0.0037) were independent indices to predict progression free survival in first line treatment. In addition, visceral obesity (HR 0.42, P=0.0016) and Memorial Sloan-Kettering Cancer Center classification (P=0.0006) independently predicted overall survival. Conclusions: The precision of CT imaging for measuring visceral fat tissue provides useful clinical venue to predict prognosis for metastatic renal cell carcinoma. Visceral obesity may be a useful and independent indicator for a better prognosis in patients treated with systemic therapy for metastatic renal cell carcinoma.

Trends of metastasectomy for metastatic renal cell carcinoma and their impact on overall survival.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 620-620
Author(s):  
Christian P Meyer ◽  
Maxine Sun ◽  
Guillermo de Velasco ◽  
Quoc-Dien Trinh ◽  
Toni K. Choueiri
Keyword(s):  
Renal Cell Carcinoma ◽  
Overall Survival ◽  
Cell Carcinoma ◽  
Metastatic Renal Cell Carcinoma ◽  
Renal Cell ◽  
Survival Benefit ◽  
Private Insurance ◽  
Combined Treatment ◽  
Cancer Data ◽  
The Impact

620 Background: The treatment of metastatic renal cell carcinoma (mRCC) has profoundly changed over the last decade. There is little comprehensive evidence evaluating the role of metastasectomy (MSx) in in this context. We assessed trends and predictors of MSx and their impact on overall survival in a large national cohort. Methods: The National Cancer Data Base from 1998-2012 was queried to identify 25,455 mRCC patients with 5,315 undergoing MSx. Covariates included the application of targeted chemotherapy (CTX) and immunotherapy (ITX). Baseline descriptive and multivariable logistic regression analyzes for prediction of MSx were conducted. Trends for chemo- (CTX) and immunotherapy (ITX) as well as MSx were assessed using the annual percent change linear regression technique (EAPC). Kaplan-Meier curves and adjusted Cox-proportional hazard models assessed the impact of MSx on overall survival. Results: Compared to controls, MSx patients were significantly younger (p<0.001), had a lower CCI (p=0.03), more often private insurance (p=0.04) and a higher income (p<0.001). They were more often treated at an academic center (p<0.001), but less often received ITX/CTX (both p<0.001). The rates of MSx increased significantly over the years (9.9-24.5%, EAPC 4.52, p<0.001) while CTX (EAPC 3.08, p<0.001) increased and ITX decreased (EAPC -12.9, p<0.001). Diagnosis after 2006 (OR 1.21, 95%CI 1.02-1.23) and private insurance (OR 1.43, 95% CI 1.14-1.79) were positive predictors of MSx, whereas increasing age (OR0.98, 95%CI 0.98-0.99), black race (OR 0.73, 95%CI 0.63-0.84), ITX (OR 0.8, 95%CI 0.68-0.94) and CTX (OR 0.75, 95% 0.69-0.82) were negatively associated with MSx. The combined treatment with MSx conferred a survival benefit compared to no MSx (HR 0.75, 95%CI 0.72-0.78) and CTX alone (HR 0.82, 95%CI 0.74-0.90). Conclusions: The addition of MSx to CTX conferred a survival benefit in our study despite lower usage of MSx after CTX. This suggests a potential underutilization, which might be a consequence of underlying health care access disparities as implied by lower odds of receiving MSx in blacks and higher odds in privately insured patients.

Nephrectomy Followed by Interferon Alfa-2b Compared With Interferon Alfa-2b Alone for Metastatic Renal Cell Cancer

2021 ◽  
pp. 113-118
Author(s):  
Christopher Weight
Keyword(s):  
Renal Cell Carcinoma ◽  
Overall Survival ◽  
Cell Carcinoma ◽  
Metastatic Renal Cell Carcinoma ◽  
Renal Cell Cancer ◽  
Renal Cell ◽  
Performance Status ◽  
Cell Cancer ◽  
Interferon Alfa ◽  
Cytoreductive Nephrectomy

This chapter summarizes the findings of a landmark trial of cytoreductive nephrectomy in patients with metastatic renal cell carcinoma performed in the interferon era. All enrolled patients had a good performance status. It found overall survival extended by about 3 months in the cytoreductive-nephrectomy-plus-interferon arm versus the interferon-only arm.

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