Back to Search
Start Over
Comparative Effectiveness of Initial Surgery vs Initial Systemic Therapy for Metastatic Kidney Cancer in the Targeted Therapy Era: Analysis of a Population-based Cohort.
Comparative Effectiveness of Initial Surgery vs Initial Systemic Therapy for Metastatic Kidney Cancer in the Targeted Therapy Era: Analysis of a Population-based Cohort.
- Source :
-
Urology [Urology] 2018 Mar; Vol. 113, pp. 146-152. Date of Electronic Publication: 2017 Nov 23. - Publication Year :
- 2018
-
Abstract
- Objective: To use econometric methods to assess comparative overall survival of patients with metastatic renal cell carcinoma (mRCC) managed with initial cytoreductive nephrectomy (CN) vs initial systemic therapy. Randomized data demonstrate improved survival for CN preceding cytokine-based therapy in mRCC. This benefit may be attenuated in the contemporary mRCC era given more effective systemic therapies.<br />Methods: Patients over age 65 with mRCC from the Surveillance, Epidemiology, and End Results registries linked with Medicare claims from 2006 to 2011 were categorized by initial treatment. We applied sequential survival analysis methods to assess the association between initial CN and overall survival (OS) including Cox proportional hazards models, propensity scoring, and instrumental variable analysis to account for measured and unmeasured selection bias.<br />Results: Of 537 patients analyzed, 190 had initial CN followed by targeted therapy and 347 had initial targeted therapy. Median OS in the initial CN group was 17.4 months (interquartile range 9.8-32.0), compared with 9.2 months (interquartile range 4.3-18.0) for initial targeted therapy. Cox proportional hazards analysis revealed initial CN was associated with improved OS (hazard ratio 0.50, 95% confidence interval [CI] 0.38-0.65). Propensity matching demonstrated a survival advantage for initial CN of 5.8 months (95% CI 1.9-9.7). Accounting for unmeasured confounding with instrumental variable analysis demonstrated a trend toward improved survival with initial CN (hazard ratio 0.29 [95% CI 0.08-1.00]).<br />Conclusion: Initial CN is associated with improved survival compared with initial systemic therapy in a contemporary population-based mRCC cohort.<br /> (Copyright © 2017 Elsevier Inc. All rights reserved.)
- Subjects :
- Aged
Antineoplastic Combined Chemotherapy Protocols administration & dosage
Carcinoma, Renal Cell mortality
Carcinoma, Renal Cell pathology
Cohort Studies
Cytoreduction Surgical Procedures mortality
Disease-Free Survival
Female
Humans
Kaplan-Meier Estimate
Kidney Neoplasms mortality
Kidney Neoplasms pathology
Male
Neoplasm Invasiveness pathology
Neoplasm Metastasis
Neoplasm Staging
Nephrectomy mortality
Prognosis
Propensity Score
Proportional Hazards Models
Retrospective Studies
Risk Assessment
Survival Analysis
Treatment Outcome
Carcinoma, Renal Cell therapy
Cytoreduction Surgical Procedures methods
Kidney Neoplasms therapy
Neoadjuvant Therapy methods
Nephrectomy methods
Registries
Subjects
Details
- Language :
- English
- ISSN :
- 1527-9995
- Volume :
- 113
- Database :
- MEDLINE
- Journal :
- Urology
- Publication Type :
- Academic Journal
- Accession number :
- 29174942
- Full Text :
- https://doi.org/10.1016/j.urology.2017.11.014