title: Overall survival after immunotherapy, tyrosine kinase inhibitors and surgery in treatment of metastatic renal cell cancer: outcome of 143 consecutive patients from a single centre.
abstract: OBJECTIVE
  The aim of this study was to evaluate overall survival (OS) after treatment of metastatic renal cell carcinoma (mRCC) following the introduction of tyrosine kinase inhibitors (TKIs) and mammalian target of rapamycin (mTOR) inhibitors.
  
  
  METHODS
  One-hundred and forty-three consecutive mRCC patients were given immunotherapy (n = 59), TKIs (n = 49) or sequential therapy (IMM → TKI group; n = 35). The TKI group included patients with higher age (p < 0.001), worse performance status (p = 0.005) and higher risk profile (p < 0.001) than the other two treatment groups. Number of metastases and sites and tumour histology did not differ between groups.
  
  
  RESULTS
  First line immunotherapy gave a median OS of 16.3 months and first line TKIs 10.9 months (p = 0.003). Survival longer than 5 years was limited to immunotherapy. Sarcomatoid component, metastatic sites, papillary histology, stage, performance status and white cell blood count were related to poor OS. Using multivariate analyses to adjust for risk predictors the difference in OS disappeared. Median OS before and after introduction of TKIs was 16 months and 14 months, respectively (p = 0.189). Memorial Sloan Kettering Cancer Center (MSKCC) risk groups were related to OS (p < 0.001). Heng's prognostic criteria appeared slightly more predictive than MSKCC (p = 0.12). Metastasectomy (n = 42) may improve OS [surgery: median OS 18.8 months, 95% confidence interval (CI) 12.3-48.5; no surgery: median OS 15 months, 95% CI 10.4-16.5; p = 0.07].
  
  
  CONCLUSIONS
  MSKCC and Heng's prognostic algorithms were valid for prognostication and can be used for individual planning of treatment and follow-up. Surgical removal of metastases may improve OS.
authors: Department of Urology , Rigshospitalet, Copenhagen , Denmark.
authors: Trine Honnens
authors: TH
authors: De Lichtenberg
authors: Gregers G
authors: GG
authors: Hermann
authors: Mikael
authors: M
authors: Rørth
authors: Mari-Janne
authors: MJ
authors: Højer Larsen
authors: Zahra
authors: Z
authors: Mansourvar
authors: Mette L
authors: ML
authors: Holm
authors: Thomas
authors: T
authors: Scheike
mesh_terms: D000368:Aged; D000465:Algorithms; D002292:Carcinoma, Renal Cell / Q000401:mortality* / Q000556:secondary / Q000628:therapy*; D003131:Combined Modality Therapy; D003718:Denmark; D004791:Enzyme Inhibitors / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007167:Immunotherapy; D007211:Indoles / Q000627:therapeutic use; D007680:Kidney Neoplasms / Q000401:mortality* / Q000556:secondary / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D009536:Niacinamide / Q000031:analogs & derivatives / Q000627:therapeutic use; D010671:Phenylurea Compounds / Q000627:therapeutic use; D011379:Prognosis; D011505:Protein-Tyrosine Kinases / Q000037:antagonists & inhibitors*; D011758:Pyrroles / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors; D000077157:Sorafenib; D000077210:Sunitinib; D015996:Survival Rate; D058570:TOR Serine-Threonine Kinases / Q000037:antagonists & inhibitors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D004791:Enzyme Inhibitors; D007211:Indoles; D010671:Phenylurea Compounds; D011758:Pyrroles; D009536:Niacinamide; D000077157:Sorafenib; C546842:MTOR protein, human; D011505:Protein-Tyrosine Kinases; D058570:TOR Serine-Threonine Kinases; D000077210:Sunitinib
keywords: immunotherapy; metastasectomy; metastatic renal cancer; prognosis; risk groups; tyrosine kinase inhibitors