PROPENSITY SCORE-MATCHED ANALYSIS OF NEOADJUVANT VS. ADJUVANT THERAPY IN RENAL CELL CARCINOMA

IF 2.4 3区医学 Q3 ONCOLOGY

Urologic Oncology-seminars and Original Investigations Pub Date : 2025-03-01 DOI:10.1016/j.urolonc.2024.12.051

Cesare Saitta, Mimi V. Nguyen, Giacomo Musso, Kevin Hakimi, Dattatraya Patil, Hajime Tanaka, Luke Wang, Margaret F. Meagher, Dhruv Puri, Kit Yuen, Masaki Kobayashi, Shohei Fukuda, Giuseppe Garofano, Giovanni Lughezzani, Nicolò M. Buffi, Viraj Master, Ithaar H. Derweesh

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引用次数: 0

Abstract

Introduction

To compare outcomes in high-risk localized RCC (HRL-RCC) patients treated with adjuvant (AT) and neoadjuvant therapy (NT) utilizing a propensity score matched model (PSM)

Methods

We conducted a multicenter analysis for patients who underwent AT or NT. AT was defined as systemic therapy given postoperatively in absence of metastases; NT was presurgical therapy in setting of localized disease. AT and NT utilized included target molecular therapy (TMT) or immunotherapy (IO). PSM model was conducted using a nearest neighbor matching algorithm in a 1:2 ratio. Primary outcome was all-cause mortality (ACM); secondary outcomes were cancer-specific mortality (CSM) and recurrence. Cox regression multivariable analysis (MVA) was fitted to elucidate predictors of outcomes.

Results

After PSM 311 patients were analyzed [adjuvant n=221, 127 TMT vs. 94 IO; neoadjuvant n=90, 61 TMT vs. 29 IO]; median follow-up 44 (IQR 20-74) months. MVA revealed AT as associated with increased ACM (HR=1.97, p=0.007), CSM (HR=2.37, p=0.007) and recurrence (HR 1.64, p=0.02). Sub-analysis of AT cohort revealed IO to be associated with decreased ACM (HR 0.59, p=0.015). In the neoadjuvant cohort TMT and IO were associated with decreased ACM (HR 0.49; p=0.016; HR 0.32, p=0.016, respectively) and CSM risk (HR 0.47, p=0.036; HR 0.18, p=0.017).

Conclusions

Our findings suggest a potential advantage of NT for HRL-RCC. Adjuvant immunotherapy was associated with decreased risk of ACM, while in the neoadjuvant TMT and IO therapy had similar outcomes. Our findings call for consideration of a clinical trial to compare outcomes of AT vs. NT.

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肾细胞癌新辅助与辅助治疗的倾向评分匹配分析

采用倾向评分匹配模型（PSM）比较高危局限性RCC （HRL-RCC）患者接受辅助治疗（AT）和新辅助治疗（NT）的结果。我们对接受AT或NT治疗的患者进行了多中心分析。AT定义为术后无转移的全身治疗；NT是局限性疾病的术前治疗方法。AT和NT的使用包括靶分子治疗（TMT）或免疫治疗（IO）。采用1:2比例的最近邻匹配算法建立PSM模型。主要终点是全因死亡率（ACM）；次要结局是癌症特异性死亡率（CSM）和复发率。采用Cox回归多变量分析（MVA）阐明预测因素。结果经PSM分析311例患者[辅助n=221, TMT 127 vs IO 94；新辅助剂n=90, 61 TMT vs. 29 IO]；中位随访44个月（IQR 20-74）。MVA显示AT与ACM升高（HR=1.97, p=0.007）、CSM （HR=2.37, p=0.007）和复发（HR 1.64, p=0.02）相关。AT队列的亚分析显示，IO与降低的ACM相关（HR 0.59, p=0.015）。在新辅助队列中，TMT和IO与降低的ACM相关(HR 0.49；p = 0.016;HR 0.32, p=0.016)和CSM风险(HR 0.47, p=0.036；HR 0.18, p=0.017)。结论我们的研究结果提示NT治疗HRL-RCC的潜在优势。辅助免疫治疗与降低ACM风险相关，而在新辅助TMT和IO治疗中具有相似的结果。我们的发现要求考虑一项临床试验来比较AT和NT的结果。

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

Urologic Oncology-seminars and Original Investigations 医学-泌尿学与肾脏学

CiteScore

4.80

自引率

3.70%

发文量

297

审稿时长

7.6 weeks

期刊介绍： Urologic Oncology: Seminars and Original Investigations is the official journal of the Society of Urologic Oncology. The journal publishes practical, timely, and relevant clinical and basic science research articles which address any aspect of urologic oncology. Each issue comprises original research, news and topics, survey articles providing short commentaries on other important articles in the urologic oncology literature, and reviews including an in-depth Seminar examining a specific clinical dilemma. The journal periodically publishes supplement issues devoted to areas of current interest to the urologic oncology community. Articles published are of interest to researchers and the clinicians involved in the practice of urologic oncology including urologists, oncologists, and radiologists.