背景:强化治疗的效果(全身治疗[ST]+细胞减灭性肾切除术(CN)与关于透明细胞转移性肾细胞癌(ccmRCC)的其他原因死亡率(OCM)的单独ST)未知。我们假设强化治疗(ST+CN)可能会导致更高的OCM,而不是单独使用ST。
方法:在监视范围内,流行病学,和最终结果数据库,所有2010-2018年接受ST+CN或单纯ST治疗的ccmRCC患者均被确定.倾向得分匹配(PSM),累积发生率图,多变量竞争风险回归分析和6个月标志分析针对OCM和癌症特异性死亡率(CSM)根据治疗状态。
结果:在2271例ccmRCC患者中,用ST+CN治疗1233例(54%),而用ST治疗1038例(46%)。1:1PSM后,OCM为5.3vs.4.6%(P=.5),CSM为73.4ST+CN中88.4%(P<.001)与单纯ST患者。在多变量竞争风险回归中,ST和CN的组合与较高的OCM无关(HR1.3;95%CI0.8-2.1;P=4),vs.ST独自一人。然而,ST和CN的组合与较低的CSM独立相关(HR0.5;95%CI0.5-0.6;P<.001),vs.ST独自一人。经过6个月的里程碑分析,这些多变量关联保持不变.
结论:目前的研究表明,在ST+CNccmRCC患者中没有OCM劣势,相对于他们单独的ST同行。相反,在ST+CN患者中记录到与较低CSM有很强的相关性,相对于他们单独的ST同行。这些关联是稳健的,经过最严格的统计调整,包括对不朽的时间偏差的控制后保持不变。
The effect of treatment intensification (systemic therapy [ST] + cytoreductive nephrectomy (CN) vs. ST alone) is unknown regarding rates of other-cause mortality (OCM) in clear-cell metastatic renal cell carcinoma (ccmRCC). We hypothesized that intensified treatment (ST + CN) may result in higher OCM, than when ST is used alone.
Within the Surveillance, Epidemiology, and End Results database, all ccmRCC patients treated 2010-2018 either with ST + CN or ST alone were identified. Propensity score matching (PSM), cumulative incidence plots, multivariable competing risks regression analyses and 6 months\' landmark analyses addressed OCM and cancer-specific mortality (CSM) according to treatment status.
Of 2271 ccmRCC patients, 1233 (54%) were treated with ST + CN vs 1038 (46%) with ST alone. After 1:1 PSM, OCM was 5.3 vs. 4.6 % (P = .5) and CSM was 73.4 vs. 88.4% (P < .001) in ST + CN vs. ST alone patients. In multivariable competing risks regression, the combination of ST and CN was not associated with higher OCM (HR 1.3; 95% CI 0.8-2.1; P = .4), vs. ST alone. However, the combination of ST and CN was independently associated with lower CSM (HR 0.5; 95% CI 0.5-0.6; P < .001), vs. ST alone. After 6 months\' landmark analyses, these multivariable associations remained unchanged.
The current study indicates no OCM-disadvantage in ST + CN ccmRCC patients, relative to their ST alone counterparts. Conversely, a strong association with lower CSM was recorded in ST + CN patients, relative to their ST alone counterparts. These associations are robust and remained unchanged after strictest statistical adjustment including control for immortal time bias.