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Xu LL, Cheng TC, Xiang NJ, Chen P, Jiang ZW, Liu XX. Risk factors for severe low anterior resection syndrome in patients with rectal cancer undergoing sphincter‑preserving resection: A systematic review and meta‑analysis. Oncol Lett 2024; 27:30. [PMID: 38108080 PMCID: PMC10722524 DOI: 10.3892/ol.2023.14163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 09/04/2023] [Indexed: 12/19/2023] Open
Abstract
The present study aimed to evaluate the incidence and risk factors of severe low anterior resection syndrome (LARS) in patients with rectal cancer undergoing sphincter-preserving resection, and to provide the clinical basis and reference for the treatment of rectal cancer and the prevention of LARS. Studies on the incidence and risk factors for severe LARS in patients with rectal cancer undergoing sphincter-preserving resection were searched using PubMed, Embase, Cochrane Library, Scopus and Web of Science, according to the inclusion and exclusion criteria. After evaluating the study quality and extracting relevant data, RevMan 5.2 and STATA software were used to conduct a meta-analysis. A total of 12 articles were considered eligible for the present meta-analysis. Within these articles, there were 3,877 cases of sphincter-preserving resection for rectal cancer and 1,589 cases of severe LARS; the incidence of severe LARS was 40.99%. The results of the meta-analysis revealed that sex [female; odds ratio (OR), 6.54; 95% CI, 3.63-11.76; Z, 6.27; P<0.00001], radiotherapy and chemotherapy (OR, 3.45; 95% CI, 2.29-5.21; Z, 5.91; P<0.00001), total mesorectal excision (TME; OR, 4.39; 95% CI, 3.32-5.79; Z, 10.41; P<0.00001), and distance between tumor and anal margin (OR, 2.74; 95% CI, 0.86-8.72; Z, 1.70; P<0.00001) may be the risk factors for severe LARS.
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Affiliation(s)
- Lu-Lu Xu
- The First Clinical Medical College, Nanjing University of Traditional Chinese Medicine, Nanjing, Jiangsu 210023, P.R. China
| | - Tian-Cheng Cheng
- The First Clinical Medical College, Nanjing University of Traditional Chinese Medicine, Nanjing, Jiangsu 210023, P.R. China
| | - Neng-Jun Xiang
- The First Clinical Medical College, Nanjing University of Traditional Chinese Medicine, Nanjing, Jiangsu 210023, P.R. China
| | - Peng Chen
- The First Clinical Medical College, Nanjing University of Traditional Chinese Medicine, Nanjing, Jiangsu 210023, P.R. China
| | - Zhi-Wei Jiang
- Department of General Surgery, Jiangsu Provincial Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Traditional Chinese Medicine, Nanjing, Jiangsu 210029, P.R. China
| | - Xin-Xin Liu
- Department of General Surgery, Jiangsu Provincial Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Traditional Chinese Medicine, Nanjing, Jiangsu 210029, P.R. China
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Ohba K, Monji K, Osawa T, Yamana K, Yasuda Y, Tanaka H, Nakagawa Y, Fukuyama T, Matsubara N, Uemura H, Sakai H, Eto M. Comprehensive investigation of clinicopathological and immunological features to determine prognostic impact in metastatic renal cell carcinoma: The JEWEL study. Int J Urol 2023; 30:977-984. [PMID: 37434386 DOI: 10.1111/iju.15244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 06/20/2023] [Indexed: 07/13/2023]
Abstract
OBJECTIVES Current prognostic models for metastatic renal cell carcinoma (mRCC) are likely inaccurate due to recent treatment advances and improved survival outcomes. The JEWEL study used a data set from patients who received tyrosine kinase inhibitors (TKIs) to explore the prognostic impact of the tumor immune environment in the absence of immune checkpoint inhibitor intervention. METHODS The primary analysis population comprised 569 of the 770 Japanese patients enrolled in the ARCHERY study who received first-line TKIs. Multivariable Cox proportional hazard models were used to identify factors associated with the primary (overall survival [OS]) and secondary outcomes (treatment duration) using 34 candidate explanatory variables. RESULTS Median OS was 34.1 months (95% CI, 30.4-37.6) in the primary analysis population. A considerable negative prognostic impact (descriptive p ≤ 0.0005) on OS was seen with lactate dehydrogenase (LDH) >1.5 × upper limit of normal (adjusted HR [aHR], 3.30; 95% CI, 2.19-4.98), Eastern Cooperative Oncology Group performance status (ECOG PS) ≥2 (aHR, 2.14; 95% CI, 1.56-2.94), World Health Organization (WHO)/International Society of Urological Pathology (ISUP) Grade 4 (aHR, 1.89; 95% CI, 1.43-2.51), C-reactive protein (CRP) level ≥0.3 (aHR, 1.78; 95% CI, 1.40-2.26), and age ≥75 years (aHR, 1.65; 95% CI, 1.24-2.18) in the multivariable analysis. PD-L1 and immunophenotype affected OS in univariable analyses but were not selected in the multivariable model as explanatory variables. CONCLUSIONS JEWEL identified sex, age, ECOG PS, liver and bone metastases, CRP levels, WHO/ISUP grade, LDH, and albumin levels as key prognostic factors for OS after first-line TKI therapy for mRCC.
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Affiliation(s)
- Kojiro Ohba
- Department of Urology and Renal Transplantation, Nagasaki University Hospital, Nagasaki, Japan
| | - Keisuke Monji
- Department of Urology, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Takahiro Osawa
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo-shi, Hokkaido, Japan
| | - Kazutoshi Yamana
- Departments of Urology and Molecular Urology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yosuke Yasuda
- Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Hajime Tanaka
- Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Yuki Nakagawa
- Clinical Development Division, Chugai Pharmaceutical Co, Ltd, Tokyo, Japan
| | - Tamaki Fukuyama
- Medical Affairs Division, Chugai Pharmaceutical Co, Ltd, Tokyo, Japan
| | - Nobuaki Matsubara
- Department of Medical Urology, National Cancer Center Hospital East, Chiba, Japan
| | - Hirotsugu Uemura
- Department of Urology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Hideki Sakai
- Department of Urology and Renal Transplantation, Nagasaki University Hospital, Nagasaki, Japan
| | - Masatoshi Eto
- Department of Urology, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
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Maurits JS, van der Zanden LF, Diekstra MH, Ambert V, Castellano D, Garcia-Donas J, Troyas RG, Guchelaar HJ, Jaehde U, Junker K, Martinez-Cardus A, Radu MT, Rodriguez-Antona C, Roessler M, Warren A, Eisen T, Oosterwijk E, Kiemeney LA, Vermeulen SH. Logical Imputation to Optimize Prognostic Risk Classification in Metastatic Renal Cell Cancer. KIDNEY CANCER 2022. [DOI: 10.3233/kca-220007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Application of the MSKCC and IMDC models is recommended for prognostication in metastatic renal cell cancer (mRCC). Patient classification in MSKCC and IMDC risk groups in real-world observational studies is often hampered by missing data on required pre-treatment characteristics. OBJECTIVE: To evaluate the effect of application of easy-to-use logical, or deductive, imputation on MSKCC and IMDC risk classification in an observational study setting. PATIENTS AND METHODS: We used data on 713 mRCC patients with first-line sunitinib treatment from our observational European multi-centre study EuroTARGET. Pre-treatment characteristics and follow-up were derived from medical files. Hospital-specific cut-off values for laboratory measurements were requested. The effect of logical imputation of missing data and consensus versus hospital-specific cut-off values on patient classification and the subsequent models’ predictive performance for progression-free and overall survival (OS) was evaluated. RESULTS: 45% of the patients had missing data for≥1 pre-treatment characteristic for either model. Still, 72% of all patients could be unambiguously classified using logical imputation. Use of consensus instead of hospital-specific cut-offs led to a shift in risk group for 12% and 7% of patients for the MSKCC and IMDC model, respectively. Using logical imputation or other cut-offs did not influence the models’ predictive performance. These were in line with previous reports (c-statistic ∼0.64 for OS) CONCLUSIONS: Logical imputation leads to a substantial increase in the proportion of patients that can be correctly classified into poor and intermediate MSKCC and IMDC risk groups in observational studies and its use in the field should be advocated.
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Affiliation(s)
| | | | - Meta H.M. Diekstra
- Department of Clinical Pharmacy & Toxicology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Pharmacology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Valentin Ambert
- University of Medicine and Pharmacy Carol Davila, Bucuresti, Romania
| | - Daniel Castellano
- Medical Oncology Department, Hospital Universitario 12 de Octubre, + 12 Research Institute, (CiberOnc), Madrid, Spain
| | - Jesus Garcia-Donas
- Medical Oncology, HM Hospitales-Centro Integral Oncológico HM Clara Campal, Madrid, Spain
| | | | - Henk-Jan Guchelaar
- Department of Clinical Pharmacy & Toxicology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ulrich Jaehde
- Institute of Pharmacy, Department of Clinical Pharmacy, University of Bonn, Bonn, Germany
| | - Kerstin Junker
- Clinic of Urology and Paediatric Urology, Saarland University, Homburg, Germany
- Department of Urology, Jena University Hospital, Jena, Germany
| | - Anna Martinez-Cardus
- Cancer Epigenetics and Biology Program, Bellvitge Biomedical Research Institute, Barcelona, Catalonia, Spain
- Institut Catala d’Oncologia (ICO), Badalona Applied Research Group in Oncology (B-ARGO Group), Institut Investigació Germans Trias i Pujol (IGTP), Badalona, Spain
| | - Marius T. Radu
- University of Medicine and Pharmacy Carol Davila, Bucuresti, Romania
- Spitalul Clinic de Nefrologie “Dr. Carol Davila”, Bucuresti, Romania
| | - Cristina Rodriguez-Antona
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre (CNIO) and Biomedical Network on Rare Diseases (CIBERER), Madrid, Spain
| | - Max Roessler
- CESAR Central Office, CESAR Central European Society for Anticancer Drug Research-EWIV, Vienna, Austria
| | - Anne Warren
- Department of Histopathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK
| | - Tim Eisen
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK
| | - Egbert Oosterwijk
- Radboud University Medical Center, Nijmegen, The Netherlands
- Cancer Epigenetics and Biology Program, Bellvitge Biomedical Research Institute, Barcelona, Catalonia, Spain
| | - Lambertus A.L.M. Kiemeney
- Radboud University Medical Center, Nijmegen, The Netherlands
- Cancer Epigenetics and Biology Program, Bellvitge Biomedical Research Institute, Barcelona, Catalonia, Spain
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Wei Z, Zhang F, Ma X, He W, Gou X, Zhang X, Xie Y. Preoperative red blood cell distribution width as an independent prognostic factor in metastatic renal cell carcinoma. Transl Oncol 2022; 23:101486. [PMID: 35839619 PMCID: PMC9287633 DOI: 10.1016/j.tranon.2022.101486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 07/02/2022] [Accepted: 07/06/2022] [Indexed: 11/23/2022] Open
Abstract
Patients with higher red blood cell distribution width (RDW) levels had worse OS and PFS. Preoperative RDW was independently associated with PFS and OS in patients with metastatic renal cell carcinoma (mRCC). Preoperative RDW can be utilized as a novel prognostic biomarker for patients with mRCC.
Objective This study aimed to explore the prognostic value of preoperative red blood cell distribution width (RDW) in patients with metastatic renal cell carcinoma (mRCC). Methods Clinicopathological data of 230 patients with mRCC treated at the First Affiliated Hospital of Chongqing Medical University and the Chinese PLA General Hospital from January 2008 to December 2018 were retrospectively analyzed. Patients were stratified according to the optimal cut-off value of RDW calculated using X-tile software. The prognostic value of RDW was analyzed using the Kaplan-Meier curve with log-rank test and univariate and multivariate Cox proportional hazards models. Results A total of 230 patients were included. The optimal cut-off value of RDW obtained using X-tile software was 13.1%. The median Progression-free survival (PFS) and Overall survival (OS) of all populations were 12.06 months (IQR: 4.73–36.9) and 32.20 months (IQR: 13.73–69.46), respectively. Kaplan–Meier curves showed that patients with high RDW had worse PFS and OS than those with low RDW (median PFS of 9.7 months vs. 17.9 months, P = 0.002, and median OS of 27.8 months vs. 45.1 months, P = 0.012, respectively). Multivariate analysis showed that RDW was an independent risk factor for PFS (HR: 1.505; 95% CI: 1.111–2.037; P = 0.008) and OS (HR: 1.626; 95% CI: 1.164–2.272; P = 0.004) in mRCC after cytoreductive nephrectomy. Conclusion Preoperative RDW was independently associated with PFS and OS in patients with mRCC and may be a potential predictor of survival outcomes in mRCC.
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Affiliation(s)
- Zongjie Wei
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016, China
| | - Fan Zhang
- Department of Urology, The Third Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Xin Ma
- Department of Urology, The Third Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Weiyang He
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016, China
| | - Xin Gou
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016, China
| | - Xu Zhang
- Department of Urology, The Third Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Yongpeng Xie
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016, China.
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Shee K, Pal SK, Wells JC, Ruiz-Morales JM, Russell K, Dudani S, Choueiri TK, Heng DY, Gore JL, Odisho AY. Interactive Data Visualization Tool for Patient-Centered Decision Making in Kidney Cancer. JCO Clin Cancer Inform 2021; 5:912-920. [PMID: 34464153 DOI: 10.1200/cci.21.00050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Patients and providers often lack clinical decision tools to enable effective shared decision making. This is especially true in the rapidly changing therapeutic landscape of metastatic kidney cancer. Using the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) criteria, a validated risk prediction tool for patients with metastatic renal cell carcinoma, we created and user-tested a novel interactive visualization for clinical use. METHODS An interactive visualization depicting IMDC criteria was created, with the final version including data for more than 4,500 patients. Usability testing was performed with nonmedical lay-users and medical oncology fellow physicians. Subjects used the tool to calculate median survival times based on IMDC criteria. User confidence was surveyed. An iterative user feedback implementation cycle was completed and informed revision of the tool. RESULTS The tool is available at CloViz-IMDC. Initially, 400 lay-users and 15 physicians completed clinical scenarios and surveys. Cumulative accuracy across scenarios was higher for physicians than lay-users (84% v 74%; P = .03). Eighty-three percent of lay-users and 87% of physicians thought the tool became intuitive with use. Sixty-eight percent of lay-users wanted to use the tool clinically compared with 87% of physicians. After revisions, the updated tool was user-tested with 100 lay-users and 15 physicians. Physicians, but not lay-users, showed significant improvement in accuracy in the updated version of the tool (90% v 67%; P = .008). Seventy-two percent of lay-users and 93% of physicians wanted to use the updated tool in a clinical setting. CONCLUSION A graphical method of interacting with a validated nomogram provides prognosis results that can be used by nonmedical lay-users and physicians, and has the potential for expanded use across many clinical conditions.
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Affiliation(s)
- Kevin Shee
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Sumanta K Pal
- Department of Medical Oncology, City of Hope National Medical Center Duarte, CA
| | - J Connor Wells
- Department of Medical Oncology, Tom Baker Cancer Centre, University of Calgary, Canada
| | | | - Kenton Russell
- Department of Urology, University of California San Francisco, San Francisco, CA
| | | | | | - Daniel Y Heng
- Department of Medical Oncology, Tom Baker Cancer Centre, University of Calgary, Canada
| | - John L Gore
- Department of Urology, University of Washington, Seattle, WA
| | - Anobel Y Odisho
- Department of Urology, University of California San Francisco, San Francisco, CA.,Center for Digital Health Innovation, University of California San Francisco, San Francisco, CA
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Barth DA, Drula R, Ott L, Fabris L, Slaby O, Calin GA, Pichler M. Circulating Non-coding RNAs in Renal Cell Carcinoma-Pathogenesis and Potential Implications as Clinical Biomarkers. Front Cell Dev Biol 2020; 8:828. [PMID: 33042985 PMCID: PMC7523432 DOI: 10.3389/fcell.2020.00828] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 08/04/2020] [Indexed: 12/13/2022] Open
Abstract
Liquid biopsy-the determination of circulating cells, proteins, DNA or RNA from biofluids through a "less invasive" approach-has emerged as a novel approach in all cancer entities. Circulating non-(protein) coding RNAs including microRNAs (miRNAs), long non-coding RNAs (lncRNAs), and YRNAs can be passively released by tissue or cell damage or actively secreted as cell-free circulating RNAs, bound to lipoproteins or carried by exosomes. In renal cell carcinoma (RCC), a growing body of evidence suggests circulating non-coding RNAs (ncRNAs) such as miRNAs, lncRNAs, and YRNAs as promising and easily accessible blood-based biomarkers for the early diagnosis of RCC as well as for the prediction of prognosis and treatment response. In addition, circulating ncRNAs could also play a role in RCC pathogenesis and progression. This review gives an overview over the current study landscape of circulating ncRNAs and their involvement in RCC pathogenesis as well as their potential utility as future biomarkers in RCC diagnosis and treatment.
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Affiliation(s)
- Dominik A Barth
- Research Unit of Non-Coding RNAs and Genome Editing, Division of Clinical Oncology, Department of Internal Medicine, Comprehensive Cancer Center Graz, Medical University of Graz, Graz, Austria.,Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Rares Drula
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.,Research Centre for Functional Genomics and Translational Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Leonie Ott
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.,Department of Tumor Biology, Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Linda Fabris
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Ondrej Slaby
- Central European Institute of Technology, Masaryk University, Brno, Czechia.,Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, Brno, Czechia
| | - George A Calin
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Martin Pichler
- Research Unit of Non-Coding RNAs and Genome Editing, Division of Clinical Oncology, Department of Internal Medicine, Comprehensive Cancer Center Graz, Medical University of Graz, Graz, Austria.,Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
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Hawkins R, Fife K, Hurst M, Wang M, Naicker N, Nolasco S, Eisen T, Matakidou A, Gordon J. Treatment patterns and health outcomes in metastatic renal cell carcinoma patients treated with targeted systemic therapies in the UK. BMC Cancer 2020; 20:670. [PMID: 32680483 PMCID: PMC7368711 DOI: 10.1186/s12885-020-07154-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 07/08/2020] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND Patients with metastatic renal cell carcinoma (mRCC) treated with targeted systemic therapies have demonstrated favourable outcomes in randomised controlled trials, however real-world evidence is limited. Thus, this study aimed to determine the effectiveness of targeted systemic therapies for patients with mRCC in routine clinical practice in the UK. METHODS A retrospective, observational, longitudinal study based on chart review of newly diagnosed adult mRCC patients treated at two UK hospitals from 2008 to 2015 was conducted. Targeted systemic therapies recommended for use in mRCC patients were evaluated across first to third lines of therapy (1LOT-3LOT). Important exclusions were treatment with cytokine therapy and within non-standard of care clinical trials. Primary outcome measure was overall survival (OS); data were analysed descriptively and using Kaplan-Meyer analysis. RESULTS 652 patients (65.3% male, 35.0% ≥70 years) were included. In 1LOT, 98.5% of patients received sunitinib or pazopanib. In 2LOT and 3LOT, 99.0 and 94.4% received axitinib or everolimus. Median OS was 12.9, 6.5 and 5.9 months at 1LOT, 2LOT and 3LOT respectively. Estimated OS at 1-year was 52.4% (95% CI: 48.6-56.4%) in 1LOT, 31.5% (25.2-39.5%) in 2LOT and 23.8% (10.1-55.9%) in 3LOT. Median OS from 1LOT in favourable, intermediate and poor MSKCC were 39.7, 15.8 and 6.1 months respectively. CONCLUSIONS In this study, treatment was consistent with current National Institute for Health and Care Excellence (NICE) guidelines for mRCC patients. Although the study population favoured poorer prognosis patients, outcomes were more favourable than those for England at the same time. However, overall survival in this 'real-world' population remains poor and indicates significant unmet need for effective and safe treatment options to improve survival among mRCC patients.
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Affiliation(s)
- Robert Hawkins
- University of Manchester and The Christie Hospital, Manchester, UK.
| | - Kate Fife
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Michael Hurst
- Health Economics and Outcomes Research Ltd, Cardiff, UK
| | - Meng Wang
- Bristol Myers Squibb Pharmaceuticals Ltd, Uxbridge, UK
| | | | - Sarah Nolasco
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Tim Eisen
- University of Cambridge, Cambridge, UK
| | | | - Jason Gordon
- Health Economics and Outcomes Research Ltd, Cardiff, UK
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Martini DJ, Liu Y, Shabto JM, Carthon BC, Hitron EE, Russler GA, Caulfield S, Kissick HT, Harris WB, Kucuk O, Master VA, Bilen MA. Novel Risk Scoring System for Patients with Metastatic Renal Cell Carcinoma Treated with Immune Checkpoint Inhibitors. Oncologist 2020; 25:e484-e491. [PMID: 32162798 PMCID: PMC7066702 DOI: 10.1634/theoncologist.2019-0578] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 11/05/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) criteria are the gold standard for risk-stratifying patients with metastatic renal cell cancer (mRCC). We developed a novel risk scoring system for patients with mRCC treated with immune checkpoint inhibitors (ICIs). METHODS We performed a retrospective analysis of 100 ICI-treated patients with mRCC at Winship Cancer Institute from 2015 to 2018. Several baseline variables were collected, including markers of inflammation, body mass index (BMI), and sites of metastatic disease, and all were considered for inclusion in our risk scoring system. Upon variable selection in multivariable model, monocyte-to-lymphocyte ratio (MLR), BMI, and number and sites of metastases at baseline were used for risk score calculation. Patients were categorized using four-level risk groups as good (risk score = 0), intermediate (risk score = 1), poor (risk score = 2), or very poor (risk score = 3-4). Cox's proportional hazard model and the Kaplan-Meier method were implemented for survival outcomes. RESULTS Most patients were male (66%) with clear cell renal cell carcinoma (72%). The majority (71%) received anti-programmed cell death protein-1 monotherapy. Our risk scoring criteria had higher Uno's concordance statistics than IMDC in predicting overall survival (OS; 0.71 vs. 0.57) and progression-free survival (0.61 vs. 0.58). Setting good risk (MLR <0.93, BMI ≥24, and D_Met = 0) as the reference, the OS hazard ratios were 29.5 (95% confidence interval [CI], 3.64-238.9), 6.58 (95% CI, 0.84-51.68), and 3.75 (95% CI, 0.49-28.57) for very poor, poor, and intermediate risk groups, respectively. CONCLUSION Risk scoring using MLR, BMI, and number and sites of metastases may be an effective way to predict survival in patients with mRCC receiving ICI. These results should be validated in a larger, prospective study. IMPLICATIONS FOR PRACTICE A risk scoring system was created for patients with metastatic renal cell carcinoma treated with immune checkpoint inhibitors. The results of this study have significant implications for practicing oncologists in the community and academic setting. Importantly, these results identify readily available risk factors that can be used clinically to risk-stratify patients with metastatic renal cell carcinoma who are treated with immune checkpoint inhibitors.
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Affiliation(s)
- Dylan J. Martini
- Department of Hematology and Medical Oncology, Emory University School of MedicineAtlantaGeorgiaUSA
- Winship Cancer Institute of Emory UniversityAtlantaGeorgiaUSA
| | - Yuan Liu
- Departments of Biostatistics and Bioinformatics, Emory UniversityAtlantaGeorgiaUSA
| | - Julie M. Shabto
- Department of Hematology and Medical Oncology, Emory University School of MedicineAtlantaGeorgiaUSA
- Winship Cancer Institute of Emory UniversityAtlantaGeorgiaUSA
| | - Bradley C. Carthon
- Department of Hematology and Medical Oncology, Emory University School of MedicineAtlantaGeorgiaUSA
- Winship Cancer Institute of Emory UniversityAtlantaGeorgiaUSA
| | - Emilie Elise Hitron
- Department of Hematology and Medical Oncology, Emory University School of MedicineAtlantaGeorgiaUSA
- Winship Cancer Institute of Emory UniversityAtlantaGeorgiaUSA
| | - Greta Anne Russler
- Department of Hematology and Medical Oncology, Emory University School of MedicineAtlantaGeorgiaUSA
- Winship Cancer Institute of Emory UniversityAtlantaGeorgiaUSA
| | - Sarah Caulfield
- Winship Cancer Institute of Emory UniversityAtlantaGeorgiaUSA
- Department of Pharmaceutical Services, Emory University School of MedicineAtlantaGeorgiaUSA
| | - Haydn T. Kissick
- Department of Urology, Emory University School of MedicineAtlantaGeorgiaUSA
- Winship Cancer Institute of Emory UniversityAtlantaGeorgiaUSA
| | - Wayne B. Harris
- Department of Hematology and Medical Oncology, Emory University School of MedicineAtlantaGeorgiaUSA
- Winship Cancer Institute of Emory UniversityAtlantaGeorgiaUSA
| | - Omer Kucuk
- Department of Hematology and Medical Oncology, Emory University School of MedicineAtlantaGeorgiaUSA
- Winship Cancer Institute of Emory UniversityAtlantaGeorgiaUSA
| | - Viraj A. Master
- Department of Urology, Emory University School of MedicineAtlantaGeorgiaUSA
| | - Mehmet Asim Bilen
- Department of Hematology and Medical Oncology, Emory University School of MedicineAtlantaGeorgiaUSA
- Winship Cancer Institute of Emory UniversityAtlantaGeorgiaUSA
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Pandey Y, Matin A, Broadfoot B, Kunthur A. Clinical and histological response to combination nivolumab and ipilimumab in metastatic renal cell carcinoma. Proc (Bayl Univ Med Cent) 2020; 33:258-260. [PMID: 32313480 DOI: 10.1080/08998280.2020.1717264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 01/11/2020] [Accepted: 01/13/2020] [Indexed: 01/05/2023] Open
Abstract
Patients with renal cell carcinoma (RCC) often remain asymptomatic until the disease is advanced, with about 25% presenting at an advanced stage. We present a case of metastatic RCC treated with combination ipilimumab and nivolumab with complete radiological and pathological response. Currently, combination nivolumab and ipilimumab is a preferred option for intermediate- and poor-risk patients with clear cell stage IV RCC.
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Affiliation(s)
- Yadav Pandey
- Department of Internal Medicine, University of Arkansas for Medical SciencesLittle RockArkansas
| | - Aasiya Matin
- Department of Hematology and Oncology, University of Arkansas for Medical SciencesLittle RockArkansas
| | - Brannon Broadfoot
- Department of Pathology, University of Arkansas for Medical SciencesLittle RockArkansas
| | - Anuradha Kunthur
- Department of Hematology and Oncology, University of Arkansas for Medical SciencesLittle RockArkansas
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10
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Savard MF, Wells JC, Graham J, Dudani S, Steinharter JA, McGregor BA, Donskov F, Bjarnason GA, Vaishampayan UN, Hansen AR, Iafolla MAJ, Zanotti G, Huynh L, Chang R, Duh MS, Heng DYC. Real-World Assessment of Clinical Outcomes Among First-Line Sunitinib Patients with Clear Cell Metastatic Renal Cell Carcinoma (mRCC) by the International mRCC Database Consortium Risk Group. Oncologist 2020; 25:422-430. [PMID: 31971318 DOI: 10.1634/theoncologist.2019-0605] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 12/19/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND International Metastatic Renal Cell Carcinoma (mRCC) Database Consortium (IMDC) risk groups are important when considering therapeutic options for first-line treatment. MATERIALS AND METHODS Adult patients with clear cell mRCC initiating first-line sunitinib between 2010 and 2018 were included in this retrospective database study. Median time to treatment discontinuation (TTD) and overall survival (OS) were estimated using Kaplan-Meier analysis. Outcomes were stratified by IMDC risk groups and evaluated for those in the combined intermediate and poor risk group and separately for those in the intermediate risk group with one versus two risk factors. RESULTS Among 1,769 patients treated with first-line sunitinib, 318 (18%) had favorable, 1,031 (58%) had intermediate, and 420 (24%) had poor IMDC risk. Across the three risk groups, patients had similar age, gender, and sunitinib initiation year. Median TTD was 15.0, 8.5, and 4.2 months in the favorable, intermediate, and poor risk groups, respectively, and 7.1 months in the combined intermediate and poor risk group. Median OS was 52.1, 31.5, and 9.8 months in the favorable, intermediate, and poor risk groups, respectively, and 23.2 months in the combined intermediate and poor risk group. Median OS (35.1 vs. 21.9 months) and TTD (10.3 vs. 6.6 months) were significantly different between intermediate risk patients with one versus two risk factors. CONCLUSION This real-world study found a median OS of 52 months for patients with favorable IMDC risk treated with first-line sunitinib, setting a new benchmark on clinical outcomes of clear cell mRCC. Analysis of intermediate risk group by one or two risk factors demonstrated distinct clinical outcomes. IMPLICATIONS FOR PRACTICE This analysis offers a contemporary benchmark for overall survival (median, 52.1 months; 95% confidence interval, 43.4-61.2) among patients with clear cell metastatic renal cell carcinoma who were treated with sunitinib as first-line therapy in a real-world setting and classified as favorable risk according to International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) risk group classification. This study demonstrates that clinical outcomes differ between IMDC risk groups as well as within the intermediate risk group based on the number of risk factors, thus warranting further consideration of risk group when counseling patients about therapeutic options and designing clinical trials.
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Affiliation(s)
| | | | - Jeffrey Graham
- CancerCare Manitoba, University of Manitoba, Winnipeg, Canada
| | | | | | | | | | | | | | | | | | | | - Lynn Huynh
- Analysis Group, Inc., Boston, Massachusetts, USA
| | - Rose Chang
- Analysis Group, Inc., Boston, Massachusetts, USA
| | - Mei S Duh
- Analysis Group, Inc., Boston, Massachusetts, USA
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11
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Konishi S, Hatakeyama S, Numakura K, Narita S, Inoue T, Saito M, Tokui N, Yamamoto H, Yoneyama T, Hashimoto Y, Yoshikawa K, Narita S, Kawaguchi T, Habuchi T, Ohyama C. Validation of the IMDC Prognostic Model in Patients With Metastatic Renal-Cell Carcinoma Treated With First-Line Axitinib: A Multicenter Retrospective Study. Clin Genitourin Cancer 2019; 17:e1080-e1089. [DOI: 10.1016/j.clgc.2019.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 07/04/2019] [Accepted: 07/15/2019] [Indexed: 02/08/2023]
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12
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Konishi S, Hatakeyama S, Tanaka T, Ikehata Y, Tanaka T, Hamano I, Fujita N, Yoneyama T, Yamamoto H, Yoneyama T, Hashimoto Y, Yoshikawa K, Kawaguchi T, Masumori N, Kitamura H, Ohyama C. C-reactive protein/albumin ratio is a predictive factor for prognosis in patients with metastatic renal cell carcinoma. Int J Urol 2019; 26:992-998. [PMID: 31342557 DOI: 10.1111/iju.14078] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 07/02/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To evaluate the effect of pretreatment C-reactive protein/albumin ratio and modified Glasgow prognostic score on the prognosis in patients with metastatic renal cell carcinoma. METHODS A retrospective study was carried out in 176 patients with metastatic renal cell carcinoma who received first-line tyrosine kinase inhibitors. The effect of adding inflammatory prognostic scores to the International Metastatic Renal Cell Carcinoma Database Consortium model (International Metastatic Renal Cell Carcinoma Database Consortium-C-reactive protein/albumin ratio and International Metastatic Renal Cell Carcinoma Database Consortium-Glasgow prognostic score models) on overall survival was evaluated using receiver operating characteristic curves. The prognostic value of inflammatory prognostic scores (C-reactive protein/albumin ratio-modified Glasgow prognostic score) was tested using the Kaplan-Meier method and Cox proportional regression models. RESULTS Patients were stratified into two groups using the cut-off value of 0.05: C-reactive protein/albumin ratio-low (<0.05) and C-reactive protein/albumin ratio-high (≥0.05). The area under the curve was significantly higher in the International Metastatic Renal Cell Carcinoma Database Consortium-C-reactive protein/albumin ratio model (0.720) than that of the International Metastatic Renal Cell Carcinoma Database Consortium model (0.689) and the International Metastatic Renal Cell Carcinoma Database Consortium-modified Glasgow prognostic score model (0.703). Significant differences were observed in overall survival stratified by the number of risk factors in the International Metastatic Renal Cell Carcinoma Database Consortium-C-reactive protein/albumin ratio risk model between one or two and three or four factors (P < 0.001), and three or four and five or more factors (P = 0.001). For the patients in the International Metastatic Renal Cell Carcinoma Database Consortium intermediate-risk group, overall survival was significantly different between the C-reactive protein/albumin ratio-low and -high groups (P = 0.001), whereas it was not significantly different between the patients with one and two International Metastatic Renal Cell Carcinoma Database Consortium risk factors (P = 0.106). CONCLUSION The C-reactive protein/albumin ratio is a simple and independent predictor of overall survival in patients with metastatic renal cell carcinoma. The predictive activity was significantly improved in the International Metastatic Renal Cell Carcinoma Database Consortium-C-reactive protein/albumin ratio model compared with the International Metastatic Renal Cell Carcinoma Database Consortium/International Metastatic Renal Cell Carcinoma Database Consortium-modified Glasgow prognostic score models.
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Affiliation(s)
- Sakae Konishi
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shingo Hatakeyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Toshiaki Tanaka
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Yoshinori Ikehata
- Department of Urology, Graduate School of Medicine, University of Toyama, Toyama, Japan
| | - Toshikazu Tanaka
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Itsuto Hamano
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Naoki Fujita
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Tohru Yoneyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hayato Yamamoto
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Takahiro Yoneyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yasuhiro Hashimoto
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | | | - Toshiaki Kawaguchi
- Department of Urology, Aomori Prefectural Central Hospital, Aomori, Japan
| | - Naoya Masumori
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Hiroshi Kitamura
- Department of Urology, Graduate School of Medicine, University of Toyama, Toyama, Japan
| | - Chikara Ohyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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13
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Okita K, Hatakeyama S, Tanaka T, Ikehata Y, Tanaka T, Fujita N, Ishibashi Y, Yamamoto H, Yoneyama T, Hashimoto Y, Yoshikawa K, Kawaguchi T, Masumori N, Kitamura H, Ohyama C. Impact of Disagreement Between Two Risk Group Models on Prognosis in Patients With Metastatic Renal-Cell Carcinoma. Clin Genitourin Cancer 2019; 17:e440-e446. [DOI: 10.1016/j.clgc.2019.01.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 01/06/2019] [Accepted: 01/08/2019] [Indexed: 12/11/2022]
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14
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Concordance Rate between Clinicians and Watson for Oncology among Patients with Advanced Gastric Cancer: Early, Real-World Experience in Korea. Can J Gastroenterol Hepatol 2019; 2019:8072928. [PMID: 30854352 PMCID: PMC6377977 DOI: 10.1155/2019/8072928] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 01/15/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUNDS/AIMS Watson for Oncology (WFO) is a cognitive technology that processes medical information by analyzing the latest evidence and guidelines. However, studies of the concordance rate between WFO and clinicians for advanced gastric cancer (AGC) are lacking. METHODS We retrospectively reviewed 65 patients with AGC who consulted WFO and the Gachon Gil Medical Center multidisciplinary team (GMDT) in 2016 and 2017. The recommendations of WFO were compared with the opinions of the GMDT. WFO provided three treatment options: recommended (first treatment option), for consideration (second treatment option), and not recommended. RESULTS In total, 65 patients (mean age 61.0 years; 44 males and 21 females) were included in the study. The concordance rate between WFO and the GMDT was 41.5% (27/65) at the recommended level and 87.7% (57/65) at the for consideration level. The main causes of discordance between WFO and the GMDT were as follows. First, WFO did not consider the medical history. Second, WFO recommended the use of agents that are considered outdated in Korea. Third, some patients wanted to be involved in a clinical trial. Fourth, some patients refused to use the biologic agents recommended by WFO for financial reasons as they were not covered by medical insurance. CONCLUSIONS The concordance rate at the recommended level was relatively low but was higher at the for consideration level. Discordances arose mainly from the different medical circumstances at the Gachon Gil Medical Center (GMC) and the Memorial Sloan Kettering Cancer Center (MSKCC), the main WFO consulting center. The utility of WFO as a tool for supporting clinical decision making could be further improved by incorporating regional guidelines.
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15
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Tsironis G, Koutsoukos K, Athanasakis K, Tsiara A, Tzannis K, Gerolympou M, Visvikis A, Oikonomopoulos G, Kollia A, Giannopoulou E, Dimitra M, Kostouros E, Papatsoris A, Dellis A, Stravodimos K, Varkarakis I, Samantas E, Aravantinos G, Kentepozidis N, Christodoulou C, Bozionelou V, Dimopoulos MA, Bamias A. Patterns of practice and pharmacoeconomic analysis of the management of patients with metastatic renal cell carcinoma (mRCC) in Greece--the CRISIS study. A retrospective analysis by the Hellenic Genitourinary Cancer Group (HGUCG). Expert Rev Pharmacoecon Outcomes Res 2018; 19:491-501. [PMID: 30417707 DOI: 10.1080/14737167.2019.1546121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background:Metastatic RCC (mRCC) treatment has been revolutionized with 11 approved targeted agents. We report patterns of practice, outcomes and pharmacoeconomic analyses after the introduction of targeted therapy. Patients and methods: CRISIS was a retrospective multicenter study of mRCCpatients who received targeted therapy . Results were related to the start of 1st-line therapy, with a cut off at 1 January 2011 in order to depict the impact of increased availability of effective options. Results: 164 patients, were included. 70.1% and 44.5% received 2nd and 3rd-line therapy, respectively. More patients were treated in 2nd-line after 1 January 2011. After a median follow-up of 55.1 months, median progression-free (PFS) and overall survival (OS) were 10.7 (95% confidence intervals [CI]: 8.3-13.7), 7.3 (95% CI: 5.1-8.6), 5.8 (95% CI: 3.8-7.8) and 34 (95% CI: 28.5-39.8), 22.4 (95% CI: 16-32.1), 18.3 (95% CI: 12.4-26.4) months for first, second and third line, respectively. Efficacy of sunitinib and pazopanib in 1st-line were similar. The mean total cost/patient was 35,012.2 Euros (standard deviation [SD]: 28,971.5). Conclusions: Our study confirms previous real-world data suggesting that continuing advances in the treatment of mRCC produce favorable outcomes in everyday practice. Pharmacoeconomic analyses are important for cost-effective utilization of emerging novel therapies.
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Affiliation(s)
- Georgiops Tsironis
- a Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital , University of Athens , Athens , Greece.,b Hellenic Genito-Urinary Cancer Group , Athens , Greece
| | - Konstantinos Koutsoukos
- a Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital , University of Athens , Athens , Greece.,b Hellenic Genito-Urinary Cancer Group , Athens , Greece
| | | | - Anna Tsiara
- a Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital , University of Athens , Athens , Greece
| | - Kimon Tzannis
- b Hellenic Genito-Urinary Cancer Group , Athens , Greece
| | - Margarita Gerolympou
- d 3rd Oncology Clinic , General Oncology Hospital of Kifisias "Ag. Anargyroi" , Athens , Greece
| | - Anastasios Visvikis
- d 3rd Oncology Clinic , General Oncology Hospital of Kifisias "Ag. Anargyroi" , Athens , Greece
| | | | | | | | | | - Efthymios Kostouros
- a Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital , University of Athens , Athens , Greece
| | - Athanasios Papatsoris
- b Hellenic Genito-Urinary Cancer Group , Athens , Greece.,f 2nd Department of Urology, Sismanoglio General Hospital , University of Athens , Athens , Greece
| | - Athanasios Dellis
- b Hellenic Genito-Urinary Cancer Group , Athens , Greece.,g 2nd Department of Surgery, Aretaieion Academic Hospital , University of Athens , Athens , Greece
| | - Konstantinos Stravodimos
- b Hellenic Genito-Urinary Cancer Group , Athens , Greece.,h 1st University Urology Clinic, Laiko Hospital , University of Athens , Athens , Greece
| | - Ioannis Varkarakis
- b Hellenic Genito-Urinary Cancer Group , Athens , Greece.,f 2nd Department of Urology, Sismanoglio General Hospital , University of Athens , Athens , Greece
| | - Epaminontas Samantas
- d 3rd Oncology Clinic , General Oncology Hospital of Kifisias "Ag. Anargyroi" , Athens , Greece
| | - Gerasimos Aravantinos
- i 2nd Oncology Clinic , General Oncology Hospital of Kifisias "Ag. Anargyroi" , Athens , Greece
| | | | | | - Vasiliki Bozionelou
- k Department of Medical Oncology , University Hospital of Heraklion , Heraklion , Greece
| | - Meletios Athanasios Dimopoulos
- a Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital , University of Athens , Athens , Greece.,b Hellenic Genito-Urinary Cancer Group , Athens , Greece
| | - Aristotle Bamias
- a Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital , University of Athens , Athens , Greece.,b Hellenic Genito-Urinary Cancer Group , Athens , Greece
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16
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Yao JX, Chen X, Xi W, Zhu YJ, Wang H, Hu XY, Guo JM. Immunoscore System for Predicting Clinical Outcome of Metastatic Renal Cell Carcinoma Patients Treated with Tyrosine Kinase Inhibitors. J Cancer 2018; 9:4099-4107. [PMID: 30519309 PMCID: PMC6277607 DOI: 10.7150/jca.27408] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 08/28/2018] [Indexed: 12/19/2022] Open
Abstract
We conducted this study to determine whether immunoscore system (IS) predicts survival in patients with metastatic renal cell carcinoma (mRCC). A total of 218 mRCC patients treated with sunitinib or sorafenib in Zhongshan Hospital, Fudan University were recruited during 2007-2017, retrospectively. CD8, CD4, Treg, PD-1 and PD-L1 expression were evaluated by immunohistochemical staining of paraffin embedded slide. Kaplan-Meier method and COX regression model were used in survival analyses. Multivariate analyses demonstrated that expressions of CD8, Treg, PD-1 and stromal PD-L1 (sPD-L1) expressions were independent predictive factors for OS, thus IS was established containing these four immunological factors. Subsequent analysis revealed that performance of IS provided good differentiation of OS and PFS. Besides, multivariate analysis identified IS as an independent prognostic factor for OS (p<0.001) and PFS (p=0.002). IS, compared with International mRCC Database Consortium (IMDC) risk model, and provided better prediction ability for OS. Results suggested that IS was a powerful prognostic factor for OS and PFS in patients with mRCC treated with tyrosine kinase inhibitors. And IS can be used as essential supplement to IMDC for outcome prediction in mRCC patients.
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Affiliation(s)
- Jia-Xi Yao
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Xiang Chen
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Wei Xi
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yan-Jun Zhu
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Hang Wang
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Xiao-Yi Hu
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Jian-Ming Guo
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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17
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Rini BI, Hutson TE, Figlin RA, Lechuga MJ, Valota O, Serfass L, Rosbrook B, Motzer RJ. Sunitinib in Patients With Metastatic Renal Cell Carcinoma: Clinical Outcome According to International Metastatic Renal Cell Carcinoma Database Consortium Risk Group. Clin Genitourin Cancer 2018; 16:298-304. [PMID: 29853320 DOI: 10.1016/j.clgc.2018.04.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 04/25/2018] [Accepted: 04/26/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Sunitinib malate, a targeted tyrosine kinase inhibitor, is standard of care for metastatic renal cell carcinoma (mRCC) and serves as the active comparator in several ongoing mRCC clinical trials. In this analysis we report benchmarks for clinical outcomes on the basis of International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) risk groups for patients treated with sunitinib for mRCC in a first-line setting. MATERIALS AND METHODS A retrospective analysis was performed on data from sunitinib-treated patients (n = 375) in the pivotal phase III trial of sunitinib versus interferon-α as first-line treatment for mRCC. Objective response rates (ORRs) were determined from independently reviewed radiologic assessments. The Kaplan-Meier method was used to estimate median progression-free survival (PFS) and median overall survival (OS) according to patient risk group. RESULTS Median PFS (95% confidence interval [CI]) was 14.1 (13.4-17.1), 10.7 (10.5-12.5), 2.4 (1.1-4.7), and 10.6 (8.1-10.9) months in sunitinib-treated patients in the IMDC favorable (n = 134), intermediate (n = 205), poor (n = 34), and intermediate + poor (n = 239) risk groups, respectively. Median OS (95% CI) was 23.0 (19.8-27.8), 5.1 (4.3-9.9), and 20.3 (16.8-23.0) months in sunitinib-treated patients in IMDC intermediate, poor, and intermediate + poor risk groups, respectively, and was not reached in the favorable risk group (>50% of patients were alive at data cutoff). ORRs (95% CI) was 53.0% (44.2%-61.7%), 33.7% (27.2%-40.6%), 11.8% (3.3%-27.5%), and 30.5% (24.8%-36.8%) in sunitinib-treated patients in IMDC favorable, intermediate, poor, and intermediate + poor risk groups, respectively. CONCLUSION Results of this retrospective analysis show differences in patient outcomes for PFS, OS, and ORR on the basis of IMDC prognostic risk group assignment for patients with mRCC.
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Affiliation(s)
- Brian I Rini
- Cleveland Clinic, Taussig Cancer Institute, Cleveland, OH.
| | | | - Robert A Figlin
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | | | | | | | | | - Robert J Motzer
- Memorial Sloan Kettering Cancer Center, Department of Oncology, New York, NY
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18
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Tanaka N, Mizuno R, Yasumizu Y, Ito K, Shirotake S, Masunaga A, Ito Y, Miyazaki Y, Hagiwara M, Kanao K, Mikami S, Nakagawa K, Momma T, Masuda T, Asano T, Oyama M, Oya M. Prognostic value of neutrophil-to-lymphocyte ratio in patients with metastatic renal cell carcinoma treated with first-line and subsequent second-line targeted therapy: A proposal of the modified-IMDC risk model11Dr. Mizuno reports grants from The Japan Agency for Medical Research and Development (AMED), personal fees from Pfizer, grants and personal fees from Novartis, during the conduct of the study. Dr. Mikami reports grants from The Japan Agency for Medical Research and Development (AMED) during the conduct of the study. Dr. Oya reports grants from The Japan Agency for Medical Research and Development (AMED), grants and personal fees from Pfizer, grants and personal fees from Novartis, personal fees from Bayer, during the conduct of the study. No potential conflicts of interest were disclosed by the other authors. Urol Oncol 2017; 35:39.e19-39.e28. [DOI: 10.1016/j.urolonc.2016.10.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 08/21/2016] [Accepted: 10/03/2016] [Indexed: 12/13/2022]
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19
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Tanaka N, Mizuno R, Shirotake S, Ito K, Yasumizu Y, Masunaga A, Ito Y, Miyazaki Y, Hagiwara M, Kanao K, Mikami S, Nakagawa K, Momma T, Masuda T, Asano T, Oyama M, Oya M. Effect of reclassification of the IMDC model in patients with metastatic renal cell carcinoma treated with targeted therapy in the first-line and second-line settings. Urol Oncol 2016; 34:293.e17-25. [DOI: 10.1016/j.urolonc.2016.02.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 02/25/2016] [Accepted: 02/28/2016] [Indexed: 01/14/2023]
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