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（Immuno-Oncology，简称IO）在转移性肾细胞癌（Metastatic Renal Cell Carcinoma，简称mRCC）中提高了总生存期（Overall Survival，简称OS）。既往的减瘤性肾切除术（Cytoreductive Nephrectomy，简称CN）和根治性肾切除术（Radical Nephrectomy，简称RN），若以治愈意图施行，其在IO治疗患者中的预后影响尚未明确界定。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个遵守MeetUro协会的意大利 referral centers 回顾性收集了287名符合条件的患者。将接受IO作为二线和三线治疗的患者纳入研究，而将接受IO作为一线治疗的患者排除在外。采用Kaplan-Meier方法和log-rank检验比较了两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之间的关联。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（246/287）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（287-246）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）。既往接受肾切除术的患者（246/287）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（287-246）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，肾切除术显示出与OS的显著关联（HR log rank 0.638；95%CI 0.416至0.980），而腺体转移仍然与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：对于先前接受过肾切除术的患者，IO治疗与OS的改善相关。进一步的 prospective trials 将评估这一问题，以指导临床医生在实际临床实践中的决策。