DataSheet_1_Impact of Previous Nephrectomy on Clinical Outcome of Metastatic Renal Carcinoma Treated With Immune-Oncology: A Real-World Study on Behalf of Meet-URO Group (MeetUro-7b).pdf

BackgroundImmune-Oncology (IO) improves Overall Survival (OS) in metastatic Renal Cell Carcinoma (mRCC). The prognostic impact of previous Cytoreductive Nephrectomy (CN) and radical nephrectomy (RN), with curative intent, in patients treated with IO is not well defined. The aim of our paper is to evaluate the impact of previous nephrectomy on outcome of mRCC patients treated with IO.Methods287 eligible patients were retrospectively collected from 16 Italian referral centers adhering to the MeetUro association. Patients treated with IO as second and third line were included, whereas patients treated with IO as first line were excluded. Kaplan–Meier method and log-rank test were performed to compare Progression Free Survival (PFS) and OS between groups. In our analysis, both CN and RN were included. The association between nephrectomy and other variables was analyzed in univariate and multivariate setting using the Cox proportional hazard model.Results246/287 (85.7%) patients had nephrectomy before IO treatment. Median PFS in patients who underwent nephrectomy (246/287) was 4.8 months (95%CI 3.9–5.7) vs 3.7 months (95%CI 1.9–5.5) in patients who did not it (HR log rank 0.78; 95%CI 0.53 to 1.15; p = 0.186). Median OS in patients who had previous nephrectomy (246/287) was 20.9 months (95%CI 17.6–24.1) vs 13 months (95%CI 7.7–18.2) in patients who did not it (HR log rank 0.504; 95%CI 0.337 to 0.755; p = 0.001). In the multivariate model, nephrectomy showed a significant association with OS (HR log rank 0.638; 95%CI 0.416 to 0.980), whereas gland metastases were still associated with better outcome in terms of both OS (HR log rank 0.487; 95%CI 0.279 to 0.852) and PFS (HR log rank 0.646; 95%CI 0.435 to 0.958).ConclusionsIO treatment, in patients who had previously undergone nephrectomy, was associated with a better outcome in terms of OS. Further prospective trials would assess this issue in order to guide clinicians in real word practice.

背景：免疫肿瘤学（Immune-Oncology，简称IO）在转移性肾细胞癌（Metastatic Renal Cell Carcinoma，简称mRCC）中可改善总体生存率（Overall Survival，简称OS）。然而，对于接受IO治疗的病患而言，既往减瘤性肾切除术（Cytoreductive Nephrectomy，简称CN）与根治性肾切除术（Radical Nephrectomy，简称RN）的预后影响尚无明确定论。本研究旨在评估既往肾切除术对接受IO治疗的mRCC患者预后的影响。方法：从16家遵循MeetUro协会规定的意大利专科中心中回顾性收集了287名符合条件（n=287）的患者。纳入了作为二线和三线治疗的IO治疗患者，而将作为一线治疗的IO治疗患者排除在外。采用Kaplan-Meier方法和log-rank检验比较了各组之间的无进展生存期（Progression Free Survival，简称PFS）和OS。在分析中，CN和RN均被纳入。使用Cox比例风险模型在单变量和多变量设置中分析了肾切除术与其他变量的关联。结果：在287名患者中，有246名（85.7%）在IO治疗之前接受了肾切除术。接受肾切除术的患者（n=246）的中位PFS为4.8个月（95%CI 3.9–5.7），而未接受肾切除术的患者（n=41）的中位PFS为3.7个月（95%CI 1.9–5.5）（HR log rank 0.78；95%CI 0.53至1.15；p=0.186）。接受既往肾切除术的患者（n=246）的中位OS为20.9个月（95%CI 17.6–24.1），而未接受肾切除术的患者（n=41）的中位OS为13个月（95%CI 7.7–18.2）（HR log rank 0.504；95%CI 0.337至0.755；p=0.001）。在多变量模型中，肾切除术与OS显示出显著的相关性（HR log rank 0.638；95%CI 0.416至0.980），而淋巴结转移仍然与OS（HR log rank 0.487；95%CI 0.279至0.852）和PFS（HR log rank 0.646；95%CI 0.435至0.958）更好的预后相关。结论：对于先前已行肾切除术的患者，IO治疗与OS改善的预后相关。进一步的随机对照试验将评估这一问题，以指导临床实践。