Long-Term Outcomes in Clear-Cell Renal Cell Carcinoma Patients Treated with Complete Metastasectomy
| Autor: | Maarten Albersen, Benoit Beuselinck, Annelies Verbiest, Lorenzo Tosco, Annouschka Laenen, Steven Joniau, Eduard Roussel, Paul Clement, Agnieszka Wozniak |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
business.industry Urology medicine.disease 03 medical and health sciences Clear cell renal cell carcinoma 0302 clinical medicine Oncology Nephrology 030220 oncology & carcinogenesis medicine Long term outcomes Complete Metastasectomy 030212 general & internal medicine business |
| Zdroj: | Kidney Cancer. 4:177-183 |
| ISSN: | 2468-4570 2468-4562 |
| Popis: | Background: Complete metastasectomy is routinely performed in selected patients with metastatic clear-cell renal cell carcinoma (ccRCC). Objectives: To assess (1) outcomes after first and repeat metastasectomy, (2) outcomes on targeted therapy in patients who underwent previous metastasectomy and (3) compare outcomes with and without metastasectomy after correction for selection bias. Methods: Metastatic ccRCC patients treated with or without metastasectomy at University Hospitals Leuven were included from prospective databases. We calculated disease-free survival (DFS), time to systemic therapy and cancer-specific survival (CSS) after metastasectomy, and progression-free survival (PFS) and CSS on 1st line sunitinib/pazopanib. We calculated propensity scores to estimate a patient’s likelihood to undergo metastasectomy. Results: We included 113 patients who underwent complete metastasectomy and 139 who did not. (1) Median DFS after complete metastasectomy was 18 mo, time to systemic therapy was 73 mo and CSS was 101 mo. 20% did not relapse during long-term follow-up. Outcomes remained favorable after repeat metastasectomy. (2) PFS and CSS on 1st line sunitinib/pazopanib were 15 mo and 35 mo. (3) The propensity scores of patients who did and did not undergo metastasectomy showed no overlap, indicating that correction for selection bias is impossible and comparison of outcomes unreliable. Conclusions: Complete metastasectomy and repeat metastasectomy can result in excellent outcomes in highly selected patients, even when its causal benefit cannot be formally assessed. Previous metastasectomy does not impair outcomes on targeted therapies. |
| Databáze: | OpenAIRE |
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