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Cytoreductive nephrectomy for metastatic renal cell carcinoma in the era of targeted therapy in the United States: a SEER analysis
- Source :
- World Journal of Urology. 31:1535-1539
- Publication Year :
- 2012
- Publisher :
- Springer Science and Business Media LLC, 2012.
-
Abstract
- Two randomized trials published in 2001 provided level 1 evidence for the use of cytoreductive nephrectomy (CyNx) for the treatment of metastatic renal cell carcinoma (mRCC). However, the regulatory approval of vascular endothelial growth factor tyrosine kinase inhibitors (VEGFR-TKI) in 2005 has left an "evidence void" regarding the use of CyNx. We evaluated the patterns in the use of CyNx in the cytokine and VEGFR-TKI eras, and the patient characteristics associated with the use of CyNx.The Surveillance, Epidemiology, and End Results registry was used to identify patients with histologically or cytologically confirmed stage IV RCC between 2001 and 2008. Patients were classified as treated during the cytokine (2001-2005) or VEGFR-TKI (2006-2008) eras. A multivariate logistic regression analysis was performed to calculate the odds of undergoing CyNx according to treatment era and socioeconomic characteristics.Overall, 1,112 of 2,448 patients (45%) underwent CyNx. CyNx use remained stable between 2001 and 2005 (50%), but decreased to 38% in 2008. Logistic regression analysis revealed that older age (OR 0.82, 95% CI: 0.68, 0.99), black race (OR 0.64, 95% CI: 0.46, 0.91), Hispanic ethnicity (OR 0.71, 95% CI: 0.54, 0.93), and treatment in the VEGFR-TKI era (OR 0.82, 95% CI: 0.68, 0.99) were independently associated with decreased use of CyNx.Use of CyNx in the United States has declined in the VEGFR-TKI era. Older patients and minorities are less likely to receive CyNx. Results of ongoing phase III trials are needed to refine the role of this treatment modality.
- Subjects :
- Male
Nephrology
Oncology
medicine.medical_specialty
medicine.drug_class
Urology
medicine.medical_treatment
urologic and male genital diseases
Nephrectomy
Article
Tyrosine-kinase inhibitor
Targeted therapy
Cohort Studies
chemistry.chemical_compound
Renal cell carcinoma
Internal medicine
medicine
Humans
Molecular Targeted Therapy
Registries
Enzyme Inhibitors
Carcinoma, Renal Cell
Aged
Neoplasm Staging
Retrospective Studies
business.industry
Retrospective cohort study
Middle Aged
medicine.disease
Kidney Neoplasms
United States
Surgery
Vascular endothelial growth factor
Logistic Models
Receptors, Vascular Endothelial Growth Factor
Treatment Outcome
chemistry
Female
business
Tyrosine kinase
SEER Program
Subjects
Details
- ISSN :
- 14338726 and 07244983
- Volume :
- 31
- Database :
- OpenAIRE
- Journal :
- World Journal of Urology
- Accession number :
- edsair.doi.dedup.....6f0b5f489388b26d156f9ea74f673143