Transition to targeted therapies improved the prognosis and increased the utilization of medical treatments among patients with synchronous metastatic renal cell cancer

Abstract Since the introduction of targeted therapies (TTs) for metastatic renal cell cancer (mRCC) in 2005, a limited amount of epidemiological data on efficacy of modern drug therapies for synchronous mRCC has been published. We present a comprehensive nationwide cohort including all cases of primarily metastasized renal cell cancer among adults diagnosed between 2005 and 2010, based on data from the Finnish Cancer Registry and patient records from treating hospitals. Applied treatment protocols and survival outcomes were analyzed. A total of 977 patients were included in the analysis; 499 patients were diagnosed between 2005 and 2007 and 478 patients were diagnosed between 2008 and 2010. The median overall survival (OS) was 8.80 months (95% confidence interval (CI): 7.60–10.02). The median OS of the patients diagnosed at the latter era was significantly better (11.1; 95% CI: 8.8–13.4 vs. 7.0; 95% CI: 5.7–8.3 months, p ≤ 0.001). A total number of 524 (53.8%) patients received drug therapy. Altogether, TTs including tyrosine kinase inhibitors, mammalian target of rapamycin inhibitors (mTORi), and vascular endothelial growth factor inhibitor covered 331 (63.2%) of first-line treatments, whereas interferon and its combinations with chemotherapy were used for 186 (35.5%) patients. The median OS rates for TT and interferon as first-line therapy groups were 19.9 (16.9–22.8) and 14.9 (12.3–17.4) months, respectively. The OS for patients who did not receive drug therapy after cytoreductive nephrectomy was dismal. We found that the OS estimate of mRCC patients in Finland has improved since the introduction of tyrosine kinase inhibitors. However, the prognosis remains poor for frail, elderly patients with an impaired performance status

Nephrectomy improves the survival of metastatic renal cell cancer patients with moderate to good performance status:results from a Finnish nation-wide population-based study from 2005 to 2010

Abstract Background: The purpose of this study was to evaluate the effects of cytoreductive nephrectomy (CN) and metastasectomies on the survival of patients with synchronous metastatic renal cell cancer (mRCC) using real-life, population-based national dataset. Methods: Nationwide data, including all cases of synchronous mRCC in Finland diagnosed on a 6-year timeframe, based on the Finnish Cancer Registry and complemented with patient records from the treating hospitals, were analyzed. Patients with Eastern Cooperative Oncology Group (ECOG) performance status 3–4 were excluded. Univariate and adjusted multivariable survival analysis were performed, including subgroup analysis for patients with different medical therapies. Nephrectomy complications were also analyzed. Results: A total of 732 patients were included in the analysis. CN was performed for 389 (53.1%) patients, whereas 68 (9.3%) patients underwent nephrectomy and metastasectomies of all lesions (surgery with curative intent). Median overall survival (OS) for patients who did not undergo nephrectomy was 5.9 (95% confidence interval [CI] = 4.6–7.2) months. Patients who had a CN had a median OS of 16.6 (95% CI = 14.2–19.1, p < 0.001) months, whereas patients who had surgery with curative intent had a median OS of 51.3 (95% CI = 36.0–66.6, p < 0.001) months. The survival benefit of CN and metastasectomies remained significant in all medical therapy subgroups and in both of the applied multivariable statistical models. Conclusions: Surgical treatment of metastatic renal cell cancer is associated with a significant survival benefit in patients with good and moderate performance status, regardless of the chosen medical therapy

Pieni munuaiskasvain eri erikoisalojen yhteisenä haasteena

Tiivistelmä Pienellä munuaiskasvaimella tarkoitetaan alle neljän senttimetrin kokoista kasvainta, joka todetaan yleensä vatsan alueen kuvauksessa sattumalöydöksenä. Pienet munuaismuutokset muodostavat haasteen niin hoitavalle lääkärille, radiologille kuin patologillekin. Kuvantamistutkimuksilla tai aina edes kasvaimesta otetulla neulanäytteellä ei voida varmasti erottaa hyvänlaatuisia kasvaimia pahanlaatuisista. Diagnostiikan epävarmuus johtaa toistuviin kuvantamistutkimuksiin ja turhiin toimenpiteisiin, aiheuttaa potilaassa ja lääkärissä huolta sekä lisää terveydenhuollon kustannuksia. Hoitavan lääkärin tehtävänä on arvioida, onko löydös potilaan kannalta kliinisesti merkittävä ja vaatiiko se seurantaa tai hoitoa. Iäkkäiden ja monisairaiden osalta on tärkeää tunnistaa, milloin potilas ei hyödy pienen munuaiskasvaimen aktiivisesta seurannasta tai hoidosta