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dc.contributor.authorKlatte, Tobiasen
dc.contributor.authorFife, Kateen
dc.contributor.authorWelsh, Sarahen
dc.contributor.authorSachdeva, Manavien
dc.contributor.authorArmitage, James Nen
dc.contributor.author'Aho, Tevitaen
dc.contributor.authorRiddick, Antony Cen
dc.contributor.authorMatakidou, Athenaen
dc.contributor.authorEisen, Timen
dc.contributor.authorStewart, Granten
dc.date.accessioned2018-02-23T11:45:01Z
dc.date.available2018-02-23T11:45:01Z
dc.date.issued2018-03en
dc.identifier.issn0724-4983
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/273484
dc.description.abstractPurpose: To test the hypothesis that cytoreductive nephrectomy (CN) improves overall survival (OS) of patients with synchronous metastatic renal cell carcinoma (mRCC), who subsequently receive targeted therapies (TT). Methods: We identified 261 patients who received TT for synchronous mRCC with or without prior CN. To achieve balance in baseline characteristics between groups, we used the inverse probability of treatment weighting (IPTW) method. We conducted OS analyses, including IPTW-adjusted Kaplan-Meier curves, Cox regression models, interaction term, landmark and sensitivity analyses. Results: Of the 261 patients, 97 (37.2%) received CN and 164 (62.8%) did not. IPTW-adjusted analyses showed a statistically significant OS benefit for patients treated with CN (HR=0.63, 95% CI 0.46-0.83, P=0.0015). While there was no statistically significant difference in OS at 3 months (P=0.97), 6 months (P=0.67), and 12 months (P=0.11) from diagnosis, a benefit for the CN group was noted at 18 months (P=0.005) and 24 months (P=0.004). On interaction term analyses, the beneficial effect of CN increased with better performance status (P=0.06), in women (P=0.03), and in patients with thrombocytosis (P=0.01). Conclusions: IPTW-adjusted analysis of our patient cohort suggests that CN improves OS of patients with synchronous mRCC treated with TT. On the whole, the survival difference appears after 12 months. Specific subgroups may particularly benefit from CN, and these subgroups warrant further investigation in prospective trials.
dc.format.mediumPrint-Electronicen
dc.languageengen
dc.publisherSpringer Nature
dc.subjectHumansen
dc.subjectCarcinoma, Renal Cellen
dc.subjectLiver Neoplasmsen
dc.subjectLung Neoplasmsen
dc.subjectKidney Neoplasmsen
dc.subjectNeoplasm Metastasisen
dc.subjectThrombocytosisen
dc.subjectAnilidesen
dc.subjectSulfonamidesen
dc.subjectPyridinesen
dc.subjectPyrimidinesen
dc.subjectPyrrolesen
dc.subjectIndolesen
dc.subjectAntineoplastic Agentsen
dc.subjectAntibodies, Monoclonalen
dc.subjectPrognosisen
dc.subjectCombined Modality Therapyen
dc.subjectNephrectomyen
dc.subjectSurvival Rateen
dc.subjectProportional Hazards Modelsen
dc.subjectProbabilityen
dc.subjectRetrospective Studiesen
dc.subjectCohort Studiesen
dc.subjectSex Factorsen
dc.subjectAgeden
dc.subjectMiddle Ageden
dc.subjectFemaleen
dc.subjectMaleen
dc.subjectKaplan-Meier Estimateen
dc.subjectMolecular Targeted Therapyen
dc.subjectCytoreduction Surgical Proceduresen
dc.titlePrognostic effect of cytoreductive nephrectomy in synchronous metastatic renal cell carcinoma: a comparative study using inverse probability of treatment weighting.en
dc.typeArticle
prism.endingPage425
prism.issueIdentifier3en
prism.publicationDate2018en
prism.publicationNameWorld journal of urologyen
prism.startingPage417
prism.volume36en
dc.identifier.doi10.17863/CAM.20543
dcterms.dateAccepted2017-12-08en
rioxxterms.versionofrecord10.1007/s00345-017-2154-xen
rioxxterms.versionAM*
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/all-rights-reserveden
rioxxterms.licenseref.startdate2018-03en
dc.contributor.orcidKlatte, Tobias [0000-0002-4392-6861]
dc.contributor.orcidWelsh, Sarah [0000-0001-5690-2677]
dc.contributor.orcidEisen, Tim [0000-0001-9663-4873]
dc.contributor.orcidStewart, Grant [0000-0003-3188-9140]
dc.identifier.eissn1433-8726
rioxxterms.typeJournal Article/Reviewen
rioxxterms.freetoread.startdate2018-12-18


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