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1794 OUTCOMES WITH NEPHRECTOMY FOR METASTATIC KIDNEY CANCER IN THE ERA OF TARGETED THERAPY
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THE JOURNAL OF UROLOGY姞
sin system inhibitors and HMG-CoA reductase inhibitors (HR 0.303, 95% CI 0.094-0.978, p⫽0.046) were significantly associated with cancer-specific mortality. CONCLUSIONS: Angiotensin system inhibitors and HMG-CoA reductase inhibitors improved the outcome of targeted therapy in metastatic renal cell carcinoma in this study. Combined use of angiotensin system inhibitors and HMG-CoA reductase inhibitors was associated with a lower risk for cancer-specific mortalitythan when these agents were used alone.
Vol. 187, No. 4S, Supplement, Tuesday, May 22, 2012
CONCLUSIONS: The benefit of nephrectomy vs. biopsy or no surgery with respect to disease-specific survival is greater in the targeted therapy era. While case selection may largely account for the improved outcome in those undergoing nephrectomy as compared to those having biopsy or no surgery, the more pronounced benefit in those with clear cell carcinoma suggests there may be a greater benefit to cytoreductive nephrectomy with targeted therapies. Source of Funding: None
1795 NUMBER OF METASTATIC SITES AND PERIOPERATIVE OUTCOMES AFTER CYTOREDUCTIVE NEPHRECTOMY: A POPULATION-BASED ANALYSES Marco Bianchi*, Milan, Italy; Quoc-Dien Trinh, Detroit, MI; Maxine Sun, Montreal, Canada; Jens Hansen, Hamburg, Germany; Zhe Tian, Montreal, Canada; Manuela Tutolo, Alberto Briganti, Milan, Italy; Shahrokh Shariat, New York, NY; Paul Perrotte, Montreal, Canada; Francesco Montorsi, Milan, Italy; Pierre Karakiewicz, Montreal, Canada
Source of Funding: None
1794 OUTCOMES WITH NEPHRECTOMY FOR METASTATIC KIDNEY CANCER IN THE ERA OF TARGETED THERAPY Steve Williams*, Bronx, NY; A Ari Hakimi, New York, NY; Reza Ghavamian, Farhang Rabbani, Bronx, NY INTRODUCTION AND OBJECTIVES: While there is a benefit to cytoreductive nephrectomy for metastatic kidney cancer, it is unclear if this is greater in the era of targeted therapy. We sought to analyze the 1973-2008 Surveillance, Epidemiology and End Results (SEER) database to evaluate the impact of nephrectomy for metastatic kidney cancer, stratifying by diagnosis before or after the year 2000. METHODS: From 1973-2008, 27415 patients were diagnosed with metastatic primary kidney cancer (ICD9 code 189.0), of whom 17660 (64%) were men and 9755 (36%) women. Median patient age was 66. The decade of diagnosis was the 1970s in 2265 (8%), 1980s in 4372 (16%), 1990s in 6472 (24%) and 2000s in 14306 (52%) with the 2000s group being designated as the targeted therapy era. The primary site surgery was nephrectomy in 7933 (29%), surgery NOS in 1537 (6%), and biopsy or no surgery in 17945 (65%). Tumor grade was well, moderately and poorly/undifferentiated in 494 (2%), 1973 (7%), and 6034 (22%) patients, respectively, and unknown in 18914 (69%). The histology was coded as clear cell in 5697 (21%) patients. Cox proportional hazards analysis was used to evaluate the impact of nephrectomy vs. biopsy or no surgery on disease-specific survival, adjusting for age, grade, and gender in both the targeted therapy and non-targeted therapy eras. This analysis was repeated in the subset coded as having clear cell carcinoma. RESULTS: Patients having biopsy or no surgery were 2.32-fold (95% confidence interval (CI): 2.19-2.45) more likely to die of kidney cancer vs those having nephrectomy in the non-targeted therapy era, adjusting for other covariates, while those having biopsy or no surgery were 2.67-fold (95% CI: 2.53-2.83) more likely to die from kidney cancer vs. those undergoing nephrectomy in the targeted therapy era. The improvement in outcome with nephrectomy in the targeted therapy era was more pronounced in patients coded as having clear cell carcinoma: the adjusted hazard ratios in this subset for biopsy or no surgery vs nephrectomy were 2.31 (95% CI: 2.01-2.66) in the nontargeted therapy era and 2.82 (95% CI: 2.52-3.15) in the targeted therapy era.
INTRODUCTION AND OBJECTIVES: Cytoreductive nephrectomy (CNT) may be considered in patients with metastatic renal cell carcinoma. However, the effect of the number of metastatic sites (NMS) on postoperative events during hospitalization has never been examined. We explored the effect of NMS on five short-term RC outcomes. METHODS: Within the Nationwide Inpatient Sample, 2740 patients who underwent CNTs between years 1998 –2007 were identified. NMS was categorized as follows: 1 vs. 2 vs. ⬎3. Univariable and multivariable logistic regression analyses assessed the rate of five short-term CNT outcomes: blood transfusions, prolonged length of stay (pLOS), intraoperative and postoperative complications, as well as in-hospital mortality. Covariates consisted of adjusted for age, gender, race, CCI, hospital reagion, hospital academic status, year of surgery, insurance status, and annual hospital caseload. RESULTS: Stratification of patients according to 1, 2, and ⬎3 NMS resulted in 2163 (79%), 473 (17%) and 104 (4%) patients. Relative to patients with metastases in a single site, individuals harboring metastases in ⬎3 sites were more likely to experience any postoperative complications (32 vs. 22%, p⫽0.007), to experience a prolonged length of stay (pLOS) (63 vs. 40%, p⬍0.001), and to die during hospitalization (7.7 vs. 1.5%, respectively; p⬍0.001). Intraoperative complications (p⫽0.3) and blood transfusion rates (p⫽0.2) were not statistically significantly different between patients with a single or multiple metastatic sites. In multivariable analyses, patients harboring metastases in 2 or ⬎3 sites were 35 and 71% more likely to experience any postoperative complications, respectively (all p⫽0.01). Moreover, increasing NMS also achieved independent predictor status for prediction of pLOS and in-hospital mortality. Specifically, CNT performed in patients harboring metastases in 2 or ⬎3 sites were more frequently associated with a pLOS (OR⫽1.6 and 2.9, respectively, all p⬍0.001) and higher rates of in-hospital mortality (OR⫽2.6 and 7.1 respectively, all p⬍0.002). Finally, patients with two metastatic sites were 49% more likely to experience intraoperative complications (p⫽0.04). CONCLUSIONS: The current study identifies NMS as an independent predictor of morbidity and mortality during hospitalization following a CNT. This association warrants careful consideration in patient counseling and clinical decision-making. Source of Funding: None
THE JOURNAL OF UROLOGY姞
sin system inhibitors and HMG-CoA reductase inhibitors (HR 0.303, 95% CI 0.094-0.978, p⫽0.046) were significantly associated with cancer-specific mortality. CONCLUSIONS: Angiotensin system inhibitors and HMG-CoA reductase inhibitors improved the outcome of targeted therapy in metastatic renal cell carcinoma in this study. Combined use of angiotensin system inhibitors and HMG-CoA reductase inhibitors was associated with a lower risk for cancer-specific mortalitythan when these agents were used alone.
Vol. 187, No. 4S, Supplement, Tuesday, May 22, 2012
CONCLUSIONS: The benefit of nephrectomy vs. biopsy or no surgery with respect to disease-specific survival is greater in the targeted therapy era. While case selection may largely account for the improved outcome in those undergoing nephrectomy as compared to those having biopsy or no surgery, the more pronounced benefit in those with clear cell carcinoma suggests there may be a greater benefit to cytoreductive nephrectomy with targeted therapies. Source of Funding: None
1795 NUMBER OF METASTATIC SITES AND PERIOPERATIVE OUTCOMES AFTER CYTOREDUCTIVE NEPHRECTOMY: A POPULATION-BASED ANALYSES Marco Bianchi*, Milan, Italy; Quoc-Dien Trinh, Detroit, MI; Maxine Sun, Montreal, Canada; Jens Hansen, Hamburg, Germany; Zhe Tian, Montreal, Canada; Manuela Tutolo, Alberto Briganti, Milan, Italy; Shahrokh Shariat, New York, NY; Paul Perrotte, Montreal, Canada; Francesco Montorsi, Milan, Italy; Pierre Karakiewicz, Montreal, Canada
Source of Funding: None
1794 OUTCOMES WITH NEPHRECTOMY FOR METASTATIC KIDNEY CANCER IN THE ERA OF TARGETED THERAPY Steve Williams*, Bronx, NY; A Ari Hakimi, New York, NY; Reza Ghavamian, Farhang Rabbani, Bronx, NY INTRODUCTION AND OBJECTIVES: While there is a benefit to cytoreductive nephrectomy for metastatic kidney cancer, it is unclear if this is greater in the era of targeted therapy. We sought to analyze the 1973-2008 Surveillance, Epidemiology and End Results (SEER) database to evaluate the impact of nephrectomy for metastatic kidney cancer, stratifying by diagnosis before or after the year 2000. METHODS: From 1973-2008, 27415 patients were diagnosed with metastatic primary kidney cancer (ICD9 code 189.0), of whom 17660 (64%) were men and 9755 (36%) women. Median patient age was 66. The decade of diagnosis was the 1970s in 2265 (8%), 1980s in 4372 (16%), 1990s in 6472 (24%) and 2000s in 14306 (52%) with the 2000s group being designated as the targeted therapy era. The primary site surgery was nephrectomy in 7933 (29%), surgery NOS in 1537 (6%), and biopsy or no surgery in 17945 (65%). Tumor grade was well, moderately and poorly/undifferentiated in 494 (2%), 1973 (7%), and 6034 (22%) patients, respectively, and unknown in 18914 (69%). The histology was coded as clear cell in 5697 (21%) patients. Cox proportional hazards analysis was used to evaluate the impact of nephrectomy vs. biopsy or no surgery on disease-specific survival, adjusting for age, grade, and gender in both the targeted therapy and non-targeted therapy eras. This analysis was repeated in the subset coded as having clear cell carcinoma. RESULTS: Patients having biopsy or no surgery were 2.32-fold (95% confidence interval (CI): 2.19-2.45) more likely to die of kidney cancer vs those having nephrectomy in the non-targeted therapy era, adjusting for other covariates, while those having biopsy or no surgery were 2.67-fold (95% CI: 2.53-2.83) more likely to die from kidney cancer vs. those undergoing nephrectomy in the targeted therapy era. The improvement in outcome with nephrectomy in the targeted therapy era was more pronounced in patients coded as having clear cell carcinoma: the adjusted hazard ratios in this subset for biopsy or no surgery vs nephrectomy were 2.31 (95% CI: 2.01-2.66) in the nontargeted therapy era and 2.82 (95% CI: 2.52-3.15) in the targeted therapy era.
INTRODUCTION AND OBJECTIVES: Cytoreductive nephrectomy (CNT) may be considered in patients with metastatic renal cell carcinoma. However, the effect of the number of metastatic sites (NMS) on postoperative events during hospitalization has never been examined. We explored the effect of NMS on five short-term RC outcomes. METHODS: Within the Nationwide Inpatient Sample, 2740 patients who underwent CNTs between years 1998 –2007 were identified. NMS was categorized as follows: 1 vs. 2 vs. ⬎3. Univariable and multivariable logistic regression analyses assessed the rate of five short-term CNT outcomes: blood transfusions, prolonged length of stay (pLOS), intraoperative and postoperative complications, as well as in-hospital mortality. Covariates consisted of adjusted for age, gender, race, CCI, hospital reagion, hospital academic status, year of surgery, insurance status, and annual hospital caseload. RESULTS: Stratification of patients according to 1, 2, and ⬎3 NMS resulted in 2163 (79%), 473 (17%) and 104 (4%) patients. Relative to patients with metastases in a single site, individuals harboring metastases in ⬎3 sites were more likely to experience any postoperative complications (32 vs. 22%, p⫽0.007), to experience a prolonged length of stay (pLOS) (63 vs. 40%, p⬍0.001), and to die during hospitalization (7.7 vs. 1.5%, respectively; p⬍0.001). Intraoperative complications (p⫽0.3) and blood transfusion rates (p⫽0.2) were not statistically significantly different between patients with a single or multiple metastatic sites. In multivariable analyses, patients harboring metastases in 2 or ⬎3 sites were 35 and 71% more likely to experience any postoperative complications, respectively (all p⫽0.01). Moreover, increasing NMS also achieved independent predictor status for prediction of pLOS and in-hospital mortality. Specifically, CNT performed in patients harboring metastases in 2 or ⬎3 sites were more frequently associated with a pLOS (OR⫽1.6 and 2.9, respectively, all p⬍0.001) and higher rates of in-hospital mortality (OR⫽2.6 and 7.1 respectively, all p⬍0.002). Finally, patients with two metastatic sites were 49% more likely to experience intraoperative complications (p⫽0.04). CONCLUSIONS: The current study identifies NMS as an independent predictor of morbidity and mortality during hospitalization following a CNT. This association warrants careful consideration in patient counseling and clinical decision-making. Source of Funding: None