Impact of Targeted Systemic Therapy and Radiotherapy on Patients Undergoing Spine Surgery for Metastatic Renal Cell Carcinoma.

IF 1.7 Q2 SURGERY

International Journal of Spine Surgery Pub Date : 2024-07-04 DOI:10.14444/8608

Hani Chanbour, Jeffrey W Chen, Gabriel A Bendfeldt, Lakshmi Suryateja Gangavarapu, Matthew E LaBarge, Mahmoud Ahmed, Iyan Younus, Soren Jonzzon, Steven G Roth, Silky Chotai, Brian I Rini, Leo Y Luo, Amir M Abtahi, Byron F Stephens, Scott L Zuckerman

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引用次数: 0

Abstract

Background: In patients undergoing spine surgery for renal cell carcinoma (RCC), we sought to: (1) describe patterns of postoperative targeted systemic therapy and radiotherapy (RT), (2) compare perioperative outcomes among those treated with targeted systemic therapy to those without, and (3) evaluate the impact of targeted systemic therapy and/or RT on overall survival (OS) and local recurrence (LR).

Methods: A single-institution, retrospective cohort study of patients undergoing spine surgery for metastatic RCC from 2010 to 2021 was undertaken. Treatment groups were RT alone, targeted systemic therapy alone, dual therapy consisting of RT and targeted systemic therapy, and neither therapy. Multivariable Cox regression controlled for age, race, sex, insurance, and preoperative targeted systemic therapy.

Results: Forty-nine patients underwent spine surgery for RCC. Postoperatively, 4 patients (8%) received RT alone, 19 (38.8%) targeted systemic therapy alone, 12 (24.5%) dual therapy, and 13 (28.6%) neither. All groups were similar in demographics, preoperative Karnofsky Performance Score (P = 0.372), tumor size (P = 0.413), readmissions (P = 0.884), complications (P = 0.272), Karnofsky Performance Score (P = 0.466), and Modified McCormick Scale (P = 0.980) at last follow-up. Higher 1-year survival was found in dual therapy (83.3%) compared with other therapies. OS was significantly longer in patients with dual therapy compared with other therapies (log-rank; P = 0.010). Multivariate Cox regression (HR = 0.08, 95% CI = 0.02-0.31, P < 0.001) showed longer OS in dual therapy compared with other therapies. Seven patients (14.3%) experienced LR, and a similar time to LR was found between groups (log-rank; P = 0.190).

Conclusion: In patients undergoing metastatic spine surgery for RCC, postoperative dual therapy demonstrated significantly higher 1-year survival and OS compared with other therapies.

Clinical relevance: Multidisciplinary management of metastatic RCC is necessary to ensure timely implementation of targeted systemic therapy and RT to improve outcomes.

Level of evidence: 3:

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靶向系统疗法和放疗对接受脊柱手术治疗转移性肾细胞癌患者的影响

背景：在接受脊柱手术治疗肾细胞癌（RCC）的患者中，我们试图(1）描述术后系统性靶向治疗和放射治疗（RT）的模式；（2）比较接受系统性靶向治疗和未接受系统性靶向治疗患者的围手术期结果；（3）评估系统性靶向治疗和/或RT对总生存期（OS）和局部复发（LR）的影响：方法：对2010年至2021年接受脊柱手术治疗的转移性RCC患者进行了一项单一机构的回顾性队列研究。治疗组别包括单纯 RT、单纯靶向系统疗法、RT 和靶向系统疗法组成的双重疗法以及两种疗法均不适用。多变量考克斯回归控制了年龄、种族、性别、保险和术前靶向系统治疗：49名患者接受了脊柱手术治疗RCC。术后，4 名患者（8%）单独接受了 RT 治疗，19 名患者（38.8%）单独接受了系统靶向治疗，12 名患者（24.5%）接受了双重治疗，13 名患者（28.6%）两者均未接受治疗。所有组别在人口统计学、术前卡诺夫斯基表现评分（P = 0.372）、肿瘤大小（P = 0.413）、再入院率（P = 0.884）、并发症（P = 0.272）、卡诺夫斯基表现评分（P = 0.466）和最后一次随访时的改良麦考密克量表（P = 0.980）方面相似。与其他疗法相比，双重疗法的 1 年生存率更高（83.3%）。与其他疗法相比，采用双重疗法的患者的 OS 明显更长（log-rank；P = 0.010）。多变量考克斯回归（HR = 0.08，95% CI = 0.02-0.31，P < 0.001）显示，与其他疗法相比，双重疗法的患者OS更长。7名患者（14.3%）发生了LR，不同组间发生LR的时间相似（log-rank；P = 0.190）：结论：对于接受脊柱转移性RCC手术的患者，术后双重疗法的1年生存率和OS显著高于其他疗法：转移性RCC的多学科管理对于确保及时实施靶向系统治疗和RT以改善预后非常必要：3:

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来源期刊

International Journal of Spine Surgery Medicine-Surgery

CiteScore

3.10

自引率

0.00%

发文量

162

期刊介绍： The International Journal of Spine Surgery is the official scientific journal of ISASS, the International Intradiscal Therapy Society, the Pittsburgh Spine Summit, and the Büttner-Janz Spinefoundation, and is an official partner of the Southern Neurosurgical Society. The goal of the International Journal of Spine Surgery is to promote and disseminate online the most up-to-date scientific and clinical research into innovations in motion preservation and new spinal surgery technology, including basic science, biologics, and tissue engineering. The Journal is dedicated to educating spine surgeons worldwide by reporting on the scientific basis, indications, surgical techniques, complications, outcomes, and follow-up data for promising spinal procedures.