Most Read Articles
Pearl Toh, 10 Oct 2019
Adding a LAMA* to the double combination therapy of ICS** plus LABA*** in a single inhaler improves lung function and reduces exacerbations in patients whose asthma is inadequately controlled with the combination treatment, according to the TRIMARAN and TRIGGER# studies presented at ERS 2019.
2 days ago
Environmental quality and exposure to pollution may play a small part in the development of metabolic diseases, such as diabetes, a new study has found.
Tristan Manalac, 4 days ago
Sleep deprivation impairs adolescents’ long-term retention of classroom material, according to a recent Singapore study.
6 days ago
Eating alone may help in weight management as findings of a recent study suggest that eating with friends lead to higher food intake.

Initial cytoreductive nephrectomy prolongs OS in metastatic renal cell carcinoma

15 Dec 2017

Initial cytoreductive nephrectomy (CN) provides overall survival (OS) advantage in metastatic renal cell carcinoma (mRCC) compared with initial systemic therapy, a recent study reports.

Drawing data from the Surveillance, Epidemiology and End Results registries, researchers looked at 537 elderly patients (>65 years of age) with mRCC. They conducted sequential survival analysis to evaluate the effect of initial CN on OS, as well as instrumental variable analysis to account for measured and unmeasured selection bias.

Of the patients, 190 underwent initial CN followed by targeted therapy and 347 received initial targeted therapy.

Median OS was 17.4 months (IQR, 9.8 to 32.0) in the initial CN group compared with 9.2 months (IQR 4.3 to 18.0) in the initial targeted therapy group. On Cox proportional hazards analysis, initial CN improved OS by 50 percent (95 percent CI, 0.38 to 0.65). Propensity score matching showed that initial CN was associated with a survival advantage of 5.8 months (1.9 to 9.7).

In an analysis accounting for confounding, only a trend toward improved survival with initial CN (hazard ratio, 0.29; 0.08 to 1.00) was observed.

The improved OS observed with initial CN notwithstanding, researchers noted that selection for CN in the contemporary mRCC era might be confounded by regional variation and influenced by provider uncertainty. They highlighted the need for prospective randomized controlled trials to definitively address this clinical conundrum.

Current consensus-based guidelines recommend CN in carefully selected mRCC patients with a disease that can be managed with surgical resection. This is based on high-level evidence of CN with cytokine therapy and supported by retrospective cohort studies of CN with contemporary therapies. [Eur Urol 2015;67:913-924; J Natl Compr Canc Netw 2015;13:151-159]

Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Doctor - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
Pearl Toh, 10 Oct 2019
Adding a LAMA* to the double combination therapy of ICS** plus LABA*** in a single inhaler improves lung function and reduces exacerbations in patients whose asthma is inadequately controlled with the combination treatment, according to the TRIMARAN and TRIGGER# studies presented at ERS 2019.
2 days ago
Environmental quality and exposure to pollution may play a small part in the development of metabolic diseases, such as diabetes, a new study has found.
Tristan Manalac, 4 days ago
Sleep deprivation impairs adolescents’ long-term retention of classroom material, according to a recent Singapore study.
6 days ago
Eating alone may help in weight management as findings of a recent study suggest that eating with friends lead to higher food intake.