کد مقاله کد نشریه سال انتشار مقاله انگلیسی نسخه تمام متن
3924310 1253099 2011 7 صفحه PDF دانلود رایگان
عنوان انگلیسی مقاله ISI
The Outcome of Patients Treated with Sunitinib Prior to Planned Nephrectomy in Metastatic Clear Cell Renal Cancer
موضوعات مرتبط
علوم پزشکی و سلامت پزشکی و دندانپزشکی زنان، زایمان و بهداشت زنان
پیش نمایش صفحه اول مقاله
The Outcome of Patients Treated with Sunitinib Prior to Planned Nephrectomy in Metastatic Clear Cell Renal Cancer
چکیده انگلیسی

BackgroundThe role of cytoreductive nephrectomy in metastatic clear cell renal cell carcinoma (ccRCC) is controversial.ObjectiveTo determine the outcome of patients with metastatic ccRCC who receive sunitinib prior to planned nephrectomy.Design, setting, and participantsThe study combined the data from two prospective phase 2 studies that assessed upfront sunitinib (12–16 wk) prior to nephrectomy in previously untreated patients with metastatic renal cell carcinoma (RCC). Sunitinib was discontinued during the perioperative period (median: 29 d).InterventionSunitinib 50 mg in six weekly cycles (4 wk on, 2 wk off).MeasurementsProgression-free (PFS) and overall survival (OS) using the Kaplan-Meier method.Results and limitationsTwenty-one patients (32%) had Memorial Sloan-Kettering Cancer Centre (MSKCC) poor-risk disease; 45 (68%) had intermediate-risk disease. Nephrectomy was not performed in 19 (29%), most commonly due to disease progression (n = 12). The PFS for the cohort was 6.3 mo (95% confidence interval [CI], 5.1–8.5). Seventeen (36%) patients progressed during the treatment break, 13 (76%) of whom stabilised upon reinitiating of sunitinib. The OS for the cohort was 15.2 mo (95% CI, 10.3–NA). The OS for the intermediate MSKCC risk group was significantly longer than that for the poor-risk group (26.0 mo [95% CI, 13.6–NA] and 9.0 mo [95% CI, 5.8–20.5], respectively; p < 0.01). In multivariate analysis, progression of disease prior to planned nephrectomy (hazard ratio [HR]: 5.34; 95% CI, 3.17–13.27), high Fuhrman grade (HR 3.27; 95% CI, 1.38–7.72), and MSKCC poor risk at diagnosis (HR 4.75; 95% CI, 2.05–11.02) were associated with short survival (p < 0.01). However, in the absence of randomised studies it is not possible to determine if this approach is beneficial.ConclusionsUpfront sunitinib prior to planned nephrectomy in intermediate-risk disease is associated with a median survival of >2 yr despite frequent progression during treatment break. Progression in metastatic sites prior to planned surgery and MSKCC poor-risk disease was associated with a poor outcome.

ناشر
Database: Elsevier - ScienceDirect (ساینس دایرکت)
Journal: European Urology - Volume 60, Issue 3, September 2011, Pages 448–454
نویسندگان
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