Cytoreductive nephrectomy for metastatic renal cell carcinoma in the era of targeted therapy in the United States

A SEER analysis

Che kai Tsao, Alexander C. Small, Max Kates, Erin L. Moshier, Juan P. Wisnivesky, Benjamin A. Gartrell, Guru Sonpavde, James H. Godbold, Michael A. Palese, Simon J. Hall, William K. Oh, Matthew D. Galsky

Research output: Contribution to journalArticle

Abstract

Purpose: Two randomized trials published in 2001 provided level 1 evidence for the use of cytoreductive nephrectomy (CyNx) for the treatment of metastatic renal cell carcinoma (mRCC). However, the regulatory approval of vascular endothelial growth factor tyrosine kinase inhibitors (VEGFR-TKI) in 2005 has left an "evidence void" regarding the use of CyNx. We evaluated the patterns in the use of CyNx in the cytokine and VEGFR-TKI eras, and the patient characteristics associated with the use of CyNx. Methods: The Surveillance, Epidemiology, and End Results registry was used to identify patients with histologically or cytologically confirmed stage IV RCC between 2001 and 2008. Patients were classified as treated during the cytokine (2001-2005) or VEGFR-TKI (2006-2008) eras. A multivariate logistic regression analysis was performed to calculate the odds of undergoing CyNx according to treatment era and socioeconomic characteristics. Results: Overall, 1,112 of 2,448 patients (45 %) underwent CyNx. CyNx use remained stable between 2001 and 2005 (50 %), but decreased to 38 % in 2008. Logistic regression analysis revealed that older age (OR 0.82, 95 % CI: 0.68, 0.99), black race (OR 0.64, 95 % CI: 0.46, 0.91), Hispanic ethnicity (OR 0.71, 95 % CI: 0.54, 0.93), and treatment in the VEGFR-TKI era (OR 0.82, 95 % CI: 0.68, 0.99) were independently associated with decreased use of CyNx. Conclusions: Use of CyNx in the United States has declined in the VEGFR-TKI era. Older patients and minorities are less likely to receive CyNx. Results of ongoing phase III trials are needed to refine the role of this treatment modality.

Original languageEnglish (US)
Pages (from-to)1535-1539
Number of pages5
JournalWorld Journal of Urology
Volume31
Issue number6
DOIs
StatePublished - Dec 1 2013

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Nephrectomy
Renal Cell Carcinoma
Protein-Tyrosine Kinases
Vascular Endothelial Growth Factor A
Logistic Models
Regression Analysis
Cytokines
Therapeutics
Hispanic Americans
Registries
Epidemiology

Keywords

  • Cytoreductive nephrectomy
  • Disparities
  • SEER
  • Targeted therapy
  • Tyrosine kinase inhibitor

ASJC Scopus subject areas

  • Urology

Cite this

Cytoreductive nephrectomy for metastatic renal cell carcinoma in the era of targeted therapy in the United States : A SEER analysis. / Tsao, Che kai; Small, Alexander C.; Kates, Max; Moshier, Erin L.; Wisnivesky, Juan P.; Gartrell, Benjamin A.; Sonpavde, Guru; Godbold, James H.; Palese, Michael A.; Hall, Simon J.; Oh, William K.; Galsky, Matthew D.

In: World Journal of Urology, Vol. 31, No. 6, 01.12.2013, p. 1535-1539.

Research output: Contribution to journalArticle

Tsao, CK, Small, AC, Kates, M, Moshier, EL, Wisnivesky, JP, Gartrell, BA, Sonpavde, G, Godbold, JH, Palese, MA, Hall, SJ, Oh, WK & Galsky, MD 2013, 'Cytoreductive nephrectomy for metastatic renal cell carcinoma in the era of targeted therapy in the United States: A SEER analysis', World Journal of Urology, vol. 31, no. 6, pp. 1535-1539. https://doi.org/10.1007/s00345-012-1001-3
Tsao, Che kai ; Small, Alexander C. ; Kates, Max ; Moshier, Erin L. ; Wisnivesky, Juan P. ; Gartrell, Benjamin A. ; Sonpavde, Guru ; Godbold, James H. ; Palese, Michael A. ; Hall, Simon J. ; Oh, William K. ; Galsky, Matthew D. / Cytoreductive nephrectomy for metastatic renal cell carcinoma in the era of targeted therapy in the United States : A SEER analysis. In: World Journal of Urology. 2013 ; Vol. 31, No. 6. pp. 1535-1539.
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abstract = "Purpose: Two randomized trials published in 2001 provided level 1 evidence for the use of cytoreductive nephrectomy (CyNx) for the treatment of metastatic renal cell carcinoma (mRCC). However, the regulatory approval of vascular endothelial growth factor tyrosine kinase inhibitors (VEGFR-TKI) in 2005 has left an {"}evidence void{"} regarding the use of CyNx. We evaluated the patterns in the use of CyNx in the cytokine and VEGFR-TKI eras, and the patient characteristics associated with the use of CyNx. Methods: The Surveillance, Epidemiology, and End Results registry was used to identify patients with histologically or cytologically confirmed stage IV RCC between 2001 and 2008. Patients were classified as treated during the cytokine (2001-2005) or VEGFR-TKI (2006-2008) eras. A multivariate logistic regression analysis was performed to calculate the odds of undergoing CyNx according to treatment era and socioeconomic characteristics. Results: Overall, 1,112 of 2,448 patients (45 {\%}) underwent CyNx. CyNx use remained stable between 2001 and 2005 (50 {\%}), but decreased to 38 {\%} in 2008. Logistic regression analysis revealed that older age (OR 0.82, 95 {\%} CI: 0.68, 0.99), black race (OR 0.64, 95 {\%} CI: 0.46, 0.91), Hispanic ethnicity (OR 0.71, 95 {\%} CI: 0.54, 0.93), and treatment in the VEGFR-TKI era (OR 0.82, 95 {\%} CI: 0.68, 0.99) were independently associated with decreased use of CyNx. Conclusions: Use of CyNx in the United States has declined in the VEGFR-TKI era. Older patients and minorities are less likely to receive CyNx. Results of ongoing phase III trials are needed to refine the role of this treatment modality.",
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T1 - Cytoreductive nephrectomy for metastatic renal cell carcinoma in the era of targeted therapy in the United States

T2 - A SEER analysis

AU - Tsao, Che kai

AU - Small, Alexander C.

AU - Kates, Max

AU - Moshier, Erin L.

AU - Wisnivesky, Juan P.

AU - Gartrell, Benjamin A.

AU - Sonpavde, Guru

AU - Godbold, James H.

AU - Palese, Michael A.

AU - Hall, Simon J.

AU - Oh, William K.

AU - Galsky, Matthew D.

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N2 - Purpose: Two randomized trials published in 2001 provided level 1 evidence for the use of cytoreductive nephrectomy (CyNx) for the treatment of metastatic renal cell carcinoma (mRCC). However, the regulatory approval of vascular endothelial growth factor tyrosine kinase inhibitors (VEGFR-TKI) in 2005 has left an "evidence void" regarding the use of CyNx. We evaluated the patterns in the use of CyNx in the cytokine and VEGFR-TKI eras, and the patient characteristics associated with the use of CyNx. Methods: The Surveillance, Epidemiology, and End Results registry was used to identify patients with histologically or cytologically confirmed stage IV RCC between 2001 and 2008. Patients were classified as treated during the cytokine (2001-2005) or VEGFR-TKI (2006-2008) eras. A multivariate logistic regression analysis was performed to calculate the odds of undergoing CyNx according to treatment era and socioeconomic characteristics. Results: Overall, 1,112 of 2,448 patients (45 %) underwent CyNx. CyNx use remained stable between 2001 and 2005 (50 %), but decreased to 38 % in 2008. Logistic regression analysis revealed that older age (OR 0.82, 95 % CI: 0.68, 0.99), black race (OR 0.64, 95 % CI: 0.46, 0.91), Hispanic ethnicity (OR 0.71, 95 % CI: 0.54, 0.93), and treatment in the VEGFR-TKI era (OR 0.82, 95 % CI: 0.68, 0.99) were independently associated with decreased use of CyNx. Conclusions: Use of CyNx in the United States has declined in the VEGFR-TKI era. Older patients and minorities are less likely to receive CyNx. Results of ongoing phase III trials are needed to refine the role of this treatment modality.

AB - Purpose: Two randomized trials published in 2001 provided level 1 evidence for the use of cytoreductive nephrectomy (CyNx) for the treatment of metastatic renal cell carcinoma (mRCC). However, the regulatory approval of vascular endothelial growth factor tyrosine kinase inhibitors (VEGFR-TKI) in 2005 has left an "evidence void" regarding the use of CyNx. We evaluated the patterns in the use of CyNx in the cytokine and VEGFR-TKI eras, and the patient characteristics associated with the use of CyNx. Methods: The Surveillance, Epidemiology, and End Results registry was used to identify patients with histologically or cytologically confirmed stage IV RCC between 2001 and 2008. Patients were classified as treated during the cytokine (2001-2005) or VEGFR-TKI (2006-2008) eras. A multivariate logistic regression analysis was performed to calculate the odds of undergoing CyNx according to treatment era and socioeconomic characteristics. Results: Overall, 1,112 of 2,448 patients (45 %) underwent CyNx. CyNx use remained stable between 2001 and 2005 (50 %), but decreased to 38 % in 2008. Logistic regression analysis revealed that older age (OR 0.82, 95 % CI: 0.68, 0.99), black race (OR 0.64, 95 % CI: 0.46, 0.91), Hispanic ethnicity (OR 0.71, 95 % CI: 0.54, 0.93), and treatment in the VEGFR-TKI era (OR 0.82, 95 % CI: 0.68, 0.99) were independently associated with decreased use of CyNx. Conclusions: Use of CyNx in the United States has declined in the VEGFR-TKI era. Older patients and minorities are less likely to receive CyNx. Results of ongoing phase III trials are needed to refine the role of this treatment modality.

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KW - Tyrosine kinase inhibitor

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