Upfront Versus Deferred Cytoreductive Nephrectomy in Metastatic Renal Cell Carcinoma: A Systematic Review and Individual Patient Data Meta-analysis.

IF 5.4 3区材料科学 Q2 CHEMISTRY, PHYSICAL

ACS Applied Energy Materials Pub Date : 2024-09-16 DOI:10.1016/j.euf.2024.08.002

Stepan M Esagian,Jose A Karam,Pavlos Msaouel,Dimitrios Makrakis

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引用次数: 0

Abstract

BACKGROUND AND OBJECTIVE Despite its well-established role in metastatic renal cell carcinoma (mRCC), the optimal timing of cytoreductive nephrectomy (CN) is unclear. The aim of this systematic review is to compare the overall survival (OS) between upfront (uCN) and deferred (dCN) CN. METHODS The MEDLINE, EMBASE, and Web of Science databases were queried (end of search date: August 26, 2023) for studies comparing OS between uCN and dCN in mRCC patients. We reconstructed individual patient data from published Kaplan-Meier survival curves and performed one- and two-stage meta-analyses, using 6- and 12-mo landmarks to mitigate immortal time bias. We also performed subgroup analyses according to systemic therapy (ST) type and Memorial Sloan Kettering Cancer Center (MSKCC)/International Metastatic RCC Database Consortium (IMDC) risk scores. We assessed the risk of bias using the Risk of Bias in Non-randomized Studies of Interventions and Risk of Bias 2.0 tools. KEY FINDINGS AND LIMITATIONS We identified 12 (two randomized trials and ten retrospective cohorts) eligible studies with a total of 3323 (2610 uCN and 713 dCN) patients. There were no statistically significant differences in the baseline characteristics of the two groups, other than the number of metastases and ST type. The overall risk of bias was high in nine out of 12 studies. Deferred CN was associated with superior OS in the primary analysis (hazard ratio [HR] 0.74, 95% confidence interval [CI] 0.65-0.84; 5-yr life expectancy difference 5.15 mo, 95% CI 3.23-7.08), all secondary analyses, as well as the tyrosine kinase inhibitor-treated (HR 0.61, 95% CI 0.51-0.74), immune checkpoint inhibitor-treated (HR 0.67, 95% CI 0.46-0.97), and intermediate IMDC/MSKCC risk (HR 0.73, 95% CI 0.55-0.97) subgroups. CONCLUSIONS AND CLINICAL IMPLICATIONS Deferred CN is associated with superior OS compared with uCN in mRCC patients treated with contemporary STs. Randomized studies are warranted to confirm these findings. Predictive models are needed to optimize the selection of patients most likely to benefit from dCN. PATIENT SUMMARY In this report, we compared the outcomes of nephrectomy performed before (upfront) or after (deferred) starting systemic therapy for patients with metastatic kidney cancer. We found that deferred nephrectomy is associated with superior survival compared with upfront nephrectomy, irrespective of the systemic therapy regimens used.

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转移性肾细胞癌的前期与延缓细胞再生性肾切除术：系统综述与个体患者数据 Meta 分析。

背景和目的尽管细胞切除肾切除术（CN）在转移性肾细胞癌（mRCC）中的作用已得到证实，但其最佳时机尚不明确。本系统性综述旨在比较前期（uCN）和延迟（dCN）CN的总生存率（OS）。方法在MEDLINE、EMBASE和Web of Science数据库中查询（搜索结束日期：2023年8月26日）比较mRCC患者uCN和dCN的OS的研究。我们从已发表的 Kaplan-Meier 生存曲线中重建了单个患者数据，并进行了单阶段和双阶段荟萃分析，使用 6 个月和 12 个月的地标来减轻不死时间偏差。我们还根据全身治疗（ST）类型和纪念斯隆-凯特琳癌症中心（MSKCC）/国际转移性RCC数据库联盟（IMDC）风险评分进行了亚组分析。我们使用 "非随机干预研究中的偏倚风险"（Risk of Bias in Non-randomized Studies of Interventions）和 "偏倚风险2.0"（Risk of Bias 2.0）工具评估了偏倚风险。主要发现和局限性我们确定了12项（2项随机试验和10项回顾性队列）符合条件的研究，共有3323例（2610例uCN和713例dCN）患者。除转移灶数量和 ST 类型外，两组患者的基线特征无明显统计学差异。12项研究中有9项研究的总体偏倚风险较高。在主要分析（危险比[HR] 0.74，95% 置信区间[CI] 0.65-0.84；5 年预期寿命差异 5.15 个月，95% CI 3.23-7.08）、所有次要分析以及酪氨酸激酶抑制剂治疗组（HR 0.61，95% CI 0.51-0.74）、免疫检查点抑制剂治疗组（HR 0.61，95% CI 0.51-0.74）中，延迟 CN 与较好的 OS 相关。结论和临床意义在接受当代STs治疗的mRCC患者中，与uCN相比，延迟CN与优越的OS相关。需要进行随机研究来证实这些发现。本报告比较了转移性肾癌患者在开始系统治疗之前（前期）或之后（延迟）进行肾切除术的结果。我们发现，与前期肾切除术相比，无论采用哪种系统治疗方案，延迟肾切除术都能提高患者的生存率。

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来源期刊

ACS Applied Energy Materials Materials Science-Materials Chemistry

CiteScore

10.30

自引率

6.20%

发文量

1368

期刊介绍： ACS Applied Energy Materials is an interdisciplinary journal publishing original research covering all aspects of materials, engineering, chemistry, physics and biology relevant to energy conversion and storage. The journal is devoted to reports of new and original experimental and theoretical research of an applied nature that integrate knowledge in the areas of materials, engineering, physics, bioscience, and chemistry into important energy applications.