The impact of gender and age in renal cell carcinoma: age is an independent prognostic factor in women but not men
Allan J. PantuckTobias KlatteJ.J. PatardLuca CindoloA. De La TailleJ. TostainJ-M. FerrièreChristian PfisterFairooz F. KabbinavarArie S. BelldegrunDan George
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5091 Background: Renal cell carcinoma (RCC) occurs twice as often in men as in women; however, the influence of gender on stage, grade, subtype and survival has not been studied in detail. If this imbalance in RCC incidence was related to gender-specific hormone levels, age could be a further significant variable. Methods: This study included 5,654 patients treated by nephrectomy at 10 international academic centers. Differences in gender, age, T, N, and M stage, Fuhrman grade, and histological subtype were evaluated with chi- square and Student’s t-tests. Kaplan-Meier survival estimates and Cox proportional hazards models addressed the impact of gender and age on disease-specific survival (DSS). Results: Of the 5,654 patients, 3,777 (67%) were men and 1,877 (33%) were women. Generally, women presented at lower T stages (p<0.001), less frequently had distant metastases (p<0.001) and had lower grade tumors (p<0.001). In addition, women more frequently had clear-cell (87% vs. 82%) and less frequently had papillary RCC (7% vs. 12%) than men (p<0.001). As a group, women had a 19% reduced risk of death from RCC than men (HR 0.81, 95% CI 0.73–0.90, p<0.001). Interestingly, the survival advantage for women was present to the greatest degree in the age group <40 years (p=0.0136), was intermediate in women aged 40–59 (p<0.001), and disappeared in patients aged 60 years and older (p=0.248). Among women, age was an independent predictor of DSS in multivariate analysis (HR 1.011, 95% CI 1.004–1.019, p=0.004). In contrast, age was not related to prognosis in men. Conclusions: Among women, age is an independent prognostic factor of DSS with the risk of RCC-specific death increasing by 1% with each year increase in age. As a group, women present with less advanced tumors, leading to a 19% reduced risk of RCC-specific death compared with men. This survival difference is present only in patients aged <60 years, but disappears in older patients. Since this gender based survival difference is not related to T, N, M stage, ECOG PS, or histological subtype, the role of estrogen on the development and progression of RCC needs to be studied. If a true estrogen effect on RCC does exists then the potential for hormone-targeted therapy in women will also need to be investigated. No significant financial relationships to disclose.Cite
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Objectives To compare the recurrence‐free survival of partial nephrectomy and radical nephrectomy in patients with non‐metastatic pathological T3a renal cell carcinoma. Methods We reviewed the records of 3567 patients who had undergone a nephrectomy for renal cell carcinoma at five institutions in K orea from J anuary 2000 to D ecember 2010. The clinical data of 45 patients with pathological T3a renal cell carcinoma in the partial nephrectomy group were compared with 298 patients with pathological T3a renal cell carcinoma in the radical nephrectomy group. The effects of surgical methods on recurrence‐free survival were assessed by a multivariate C ox proportional hazard analysis. All comparisons were repeated in subgroup analysis on 63 clinical T1a patients with tumors ≤4 cm. Results During a median 43‐month follow‐up period, disease recurrence occurred in two patients (4.4%) in the partial nephrectomy group, and 94 patients (31.5%) in the radical nephrectomy group. The results from a multivariate model showed that radical nephrectomy was a significant predictor of recurrence. However, in subgroup analysis that included 63 clinical T1a pathological T3a patients, the recurrence‐free survival rates were not significantly different between the two cohorts. The renal function was significantly better preserved in the partial nephrectomy cohort than in the radical nephrectomy cohort. Conclusions Partial nephrectomy provides similar recurrence‐free survival outcomes compared with radical nephrectomy in patients with clinical T1a pathological T3a renal cell carcinoma. However, there seems to be a higher risk of recurrence for large pathological T3a tumors treated by radical nephrectomy compared with small tumors treated by partial nephrectomy. Thus, large tumors with the same pathological T3a renal cell carcinoma grade could have hidden aggressive features.
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Objective: To determine the effect of bio-immunological medicine,interferon-α,in the treatment of advanced renal cell cancer after radical nephrectomy.Methods: The data of 47 cases of renal cell carcinoma at advanced stage treated with interferon-α after radical nephrectomy were reviewed and the outcomes were followed.Results: The total response rate of interferon-α was 66.0%.Conclusion: Interferon-α adminstration after radical nephrectomy is effective for the treatment of advance renal cell cancer by enhancing immune function and anti-tumor capability.
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Abstract Background Nephrectomy is considered the backbone of managing patients with localized and selected metastatic renal cell carcinoma (mRCC). The prognostic role of nephrectomy has been widely investigated with cytokines and targeted therapy, but it is still unclear in the immunotherapy era. Methods We investigated the Meet-URO-15 study dataset of 571 pretreated mRCC patients receiving nivolumab as second or further lines about the prognostic role of the previous nephrectomy (received in either the localized or metastatic setting) in the overall population and according to the Meet-URO score groups. Results Patients who underwent nephrectomy showed a significantly reduced risk of death (HR 0.44, 95% CI 0.32–0.60, p < 0.001) with a longer median overall survival (OS) (35.9 months vs 12.1 months), 1-year OS of 71.6% vs 50.5% and 2-years OS of 56.5% vs 22.0% compared to those who did not. No significant interaction between nephrectomy and the overall five Meet-URO score risk groups was observed ( p = 0.17). It was statistically significant when merging group 1 with 2 and 3 and group 4 with 5 ( p = 0.038) and associated with a longer OS for the first three prognostic groups ( p < 0.001), but not for groups 4 and 5 ( p = 0.54). Conclusions Our study suggests an overall positive impact of the previous nephrectomy on the outcome of pretreated mRCC patients receiving immunotherapy. The clinical relevance of cytoreductive nephrectomy, optimal timing and patient selection deserves further investigation, especially for patients with Meet-URO scores of 1 to 3, who are the once deriving benefit in our analyses. However, that benefit is not evident for IMDC poor-risk patients (including the Meet-URO score groups 4 and 5) and a subgroup of IMDC intermediate-risk patients defined as group 4 by the Meet-URO score.
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Partial nephrectomy has been considered an effective and efficient method in the treatment of localized renal cell carcinoma. Herein, we retrospectively review our experience with partial nephrectomy in the treatment of localized renal cell carcinoma and compared it with patients who received radical nephrectomy.From 1982 to 2005, 35 patients who received partial nephrectomy for localized renal cell carcinoma were enrolled in this study. Ten patients were female (28.6%). The median age was 70 years (range, 42-82 years). Sixteen (45.7%) patients had pathologic T1a tumors; 17 (48.6%) patients had pathologic T1b tumors and 2 (5.7%) patients had pathologicT2 tumor (7cm). In the meantime, 128 patients who had T1N0M0 renal cell carcinoma and who received radical nephrectomy were assigned to a control group. Thirty-nine patients (30.5%) were female in this group. The median age was 62 years (range, 30-83 years). The tumor characteristics, location, surgical techniques and patient survival were subsequently compared.The median tumor size in the partial nephrectomy group was 3.9cm (range, 1.5-7.0cm), and it was 4.5cm (range, 1-6.5cm) in radical nephrectomy group. The tumor size was smaller in the partial nephrectomy group (p = 0.003). Themedian follow-up period was 4.38 years (range, 0.05-17.99 years) in the partial nephrectomy group and 5.66 years (range, 0.01-22.25 years) in the radical nephrectomy group. There was no local recurrence or distant metastasis in the partial nephrectomy group. The 5-year overall survival was 85.0% compared with 91.4% in the radical nephrectomy group (p = 0.126). The 5-year disease specific survival in the partial nephrectomy group was 100%. The postoperative serum creatinine level increased to >2.0mg/dL in 5 (14.3%) patients in the partial nephrectomy group, but no patient needed hemodialysis during follow-up.From our review, partial nephrectomy is safe and provides excellent disease control in the treatment of localized renal cell carcinoma in selected patients. Renal function preservation was observed in the partial nephrectomy group, while the operated kidney showed functioning in the follow-up nuclear medicine survey.
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