Can Cytoreductive Nephrectomy Improve Outcomes of Nivolumab Treatment in Patients with Metastatic Clear-Cell Renal Carcinoma?

IF 2.8 4区医学 Q2 ONCOLOGY

Current oncology Pub Date : 2024-09-04 DOI:10.3390/curroncol31090384

Birol Ocak, Ahmet Bilgehan Sahin, Ismail Ertürk, Mustafa Korkmaz, Dilek Erdem, Umut Cakıroglu, Mustafa Karaca, Ahmet Dirican, Omer Fatih Olmez, Sabin Goktas Aydın, Ali Gökyer, Ahmet Kücükarda, Ahmet Gülmez, Perran Fulden Yumuk, Nazim Can Demircan, Abdilkerim Oyman, Teoman Sakalar, Fatih Karatas, Hacer Demir, Ayse Irem Yasin, Adem Deligonul, Bahar Dakiki, Mehmet Refik Goktug, Okan Avcı, Seher Yildiz Tacar, Nazım Serdar Turhal, Gülhan Ipek Deniz, Turgut Kacan, Erdem Cubukcu, Türkkan Evrensel

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引用次数: 0

Abstract

Background: This study aimed to investigate the effect of cytoreductive nephrectomy (CN) on the survival outcomes of nivolumab used as a subsequent therapy after the failure of at least one anti-vascular endothelial growth factor (VEGF) agent in patients with metastatic clear-cell renal-cell carcinoma (ccRCC). Methods: We included 106 de novo metastatic ccRCC patients who received nivolumab after progression on at least one anti-VEGF agent. Multivariate Cox regression analysis was performed to investigate the factors affecting survival in patients receiving nivolumab. Results: Of the 106 de novo metastatic ccRCC patients, 83 (78.3%) underwent CN. There were no statistical differences between the two groups in terms of age, gender, Eastern Cooperative Oncology Group (ECOG) score, tumor size, International Metastatic RCC Database Consortium (IMDC) risk group, number of previous treatment lines, first-line anti-VEGF therapy, or metastasis sites (p = 0.137, p = 0.608, p = 0.100, p = 0.376, p = 0.185, p = 0.776, p = 0.350, and p = 0.608, respectively). The patients who received nivolumab with CN had a longer time to treatment discontinuation (TTD) [14.5 months, 95% confidence interval (CI): 8.6–20.3] than did those without CN 6.7 months (95% CI: 3.9–9.5) (p = 0.001). The median overall survival (OS) was 22.7 months (95% CI: 16.1–29.4). The patients with CN had a median OS of 22.9 months (95% CI: 16.3–29.4), while those without CN had a median OS of 8.1 months (95% CI: 5.6–10.5) (p = 0.104). In the multivariate analysis, CN [hazard ratio (HR): 0.521; 95% CI: 0.297–0.916; p = 0.024] and the IMDC risk score (p = 0.011) were statistically significant factors affecting TTD; however, the IMDC risk score (p = 0.006) was the only significant factor for overall survival. Conclusions: Our study showed that the TTD of nivolumab was longer in metastatic ccRCC patients who underwent cytoreductive nephrectomy.

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细胞清除性肾切除术能否改善转移性透明细胞肾癌患者接受 Nivolumab 治疗的疗效？

研究背景本研究旨在探讨在至少一种抗血管内皮生长因子（VEGF）药物治疗失败后，转移性透明细胞肾细胞癌（ccRCC）患者接受细胞切除肾切除术（CN）对作为后续治疗的 nivolumab 的生存结果的影响。研究方法我们纳入了106例新发转移性ccRCC患者，这些患者在至少一种抗血管内皮生长因子药物治疗进展后接受了nivolumab治疗。进行了多变量 Cox 回归分析，以研究影响接受 nivolumab 治疗的患者生存率的因素。结果显示在106例新发转移性ccRCC患者中，83例（78.3%）接受了CN治疗。两组患者在年龄、性别、东部合作肿瘤学组（Eastern Cooperative Oncology Group，ECOG）评分、肿瘤大小、国际转移性RCC数据库联盟（International Metastatic RCC Database Consortium，IMDC）风险组别、既往治疗次数、一线抗VEGF治疗或转移部位等方面均无统计学差异（分别为P = 0.137、P = 0.608、P = 0.100、P = 0.376、P = 0.185、P = 0.776、P = 0.350和P = 0.608）。接受 nivolumab 和 CN 治疗的患者的停药时间（TTD）[14.5 个月，95% 置信区间（CI）：8.6-20.3]比未接受 CN 治疗的患者长 6.7 个月（95% CI：3.9-9.5）（p = 0.001）。中位总生存期（OS）为22.7个月（95% CI：16.1-29.4）。有 CN 的患者中位 OS 为 22.9 个月（95% CI：16.3-29.4），而无 CN 的患者中位 OS 为 8.1 个月（95% CI：5.6-10.5）（P = 0.104）。在多变量分析中，CN[危险比（HR）：0.521；95% CI：0.297-0.916；p = 0.024]和IMDC风险评分（p = 0.011）是影响TTD的具有统计学意义的因素；然而，IMDC风险评分（p = 0.006）是影响总生存期的唯一重要因素。结论我们的研究表明，接受细胞切除肾脏手术的转移性 ccRCC 患者的 nivolumab TTD 更长。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Current oncology ONCOLOGY-

CiteScore

3.30

自引率

7.70%

发文量

664

审稿时长

1 months

期刊介绍： Current Oncology is a peer-reviewed, Canadian-based and internationally respected journal. Current Oncology represents a multidisciplinary medium encompassing health care workers in the field of cancer therapy in Canada to report upon and to review progress in the management of this disease. We encourage submissions from all fields of cancer medicine, including radiation oncology, surgical oncology, medical oncology, pediatric oncology, pathology, and cancer rehabilitation and survivorship. Articles published in the journal typically contain information that is relevant directly to clinical oncology practice, and have clear potential for application to the current or future practice of cancer medicine.