title: Trends in Metastatic Kidney Cancer Survival From the Cytokine to the Targeted Therapy Era.
abstract: OBJECTIVE
  To evaluate population-based survival trends, compared to optimistic trial benchmarks, in metastatic renal cell carcinoma (mRCC). Advances in medical therapy for mRCC may be associated with survival improvements. Yet, targeted therapy trial results focus on patients with favorable-risk mRCC and may not be well disseminated at the population level.
  
  
  METHODS
  Surveillance, Epidemiology, and End Results identified adult mRCC patients diagnosed between 1990 and 2009. Survival was analyzed by treatment era (cytokine, 1990-2005; targeted therapy, 2006-2009) and stratified by histology. Multivariate Cox regression identified factors independently associated with overall survival.
  
  
  RESULTS
  We identified 14,521 eligible patients. For clear cell mRCC (N = 4149), median survival improved from 11 to 14 months before and after targeted therapy (P <.001). For RCC with sarcomatoid features (N = 608) and RCC not otherwise specified (N = 8860), survival did not change (median survival 4 months for both). For non-clear cell subtypes (N = 904), median survival improved from 7 to 9 months (P = .008). On multivariate analysis, factors associated with increased overall survival were as follows: treatment in the targeted era (hazard ratio [HR], 0.87; 95% confidence interval [CI], 0.84-0.91), clear cell histology (HR, 0.76; 95% CI, 0.73-0.80), and receipt of surgery (HR, 0.43; 95% CI, 0.41-0.46).
  
  
  CONCLUSIONS
  Population-based mRCC median survival improved but to a lesser degree than that reported in clinical trials. This represents opportunity for quality improvement in histologically guided care, use of cytoreductive nephrectomy, and development of strategies for trial-ineligible, poor-risk patients.
authors.affiliation: Department of Urology, University of Washington, Seattle, WA. Electronic address: liamcm@uw.edu.
authors.forename: Liam C
authors.initials: LC
authors.lastname: Macleod
authors.affiliation: Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA.
authors.forename: Scott S
authors.initials: SS
authors.lastname: Tykodi
authors.affiliation: Department of Urology, University of Washington, Seattle, WA.
authors.forename: Sarah K
authors.initials: SK
authors.lastname: Holt
authors.affiliation: Department of Urology, University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA.
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Wright
authors.affiliation: Department of Urology, University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA.
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Lin
authors.affiliation: Department of Pathology, University of Washington, Seattle, WA.
authors.forename: Maria S
authors.initials: MS
authors.lastname: Tretiakova
authors.affiliation: Department of Pathology, University of Washington, Seattle, WA.
authors.forename: Lawrence D
authors.initials: LD
authors.lastname: True
authors.affiliation: Department of Urology, University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA.
authors.forename: John L
authors.initials: JL
authors.lastname: Gore
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000188:drug therapy* / Q000401:mortality* / Q000556:secondary; D002986:Clinical Trials as Topic; D016207:Cytokines / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000188:drug therapy* / Q000401:mortality* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D058990:Molecular Targeted Therapy; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D055815:Young Adult
chemical_list: D016207:Cytokines