Epidemiologic trends in renal cell carcinoma in the cytokine and post-cytokine eras: A registry analysis of 28,252 patients

Derek Shek, Benjamin Tomlinson, Monica Brown, Ann Brunson, Chong-Xian Pan, Primo N Lara

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

Background: Before 2004, advanced renal cell cancer (RCC) therapy consisted primarily of cytokines such as interferon and/or interleukin-2. Subsequently, randomized trials of targeted therapies have shown a survival benefit, leading to the approval of several new agents since 2004. Whether the survival benefit seen in highly selected patients accrued to these trials has already translated to the general RCC patient population is unclear. To explore this, a large RCC patient registry was evaluated for changes in outcome between the cytokine (1998-2003) and post-cytokine (2004-2007) eras. Methods: Data from the California Cancer Registry (CCR), a population-based cancer surveillance system, was used to retrospectively analyze 28,252 patients with RCC diagnosed between 1998 and 2007. Inter-era differences in clinical variables - including year of diagnosis, histologic characteristics, age, sex, race, stage, nephrectomy status, overall survival (OS), and cause-specific survival (CSS) - were assessed. Univariate and multivariate Cox models were used. Results: Crude 3-year OS (68.2% vs. 74.6%; 2P <.001) and CSS (78.1% vs. 82.3%; 2P <.001) were significantly higher in the post-cytokine era. In multivariate analysis, the 3 strongest predictors for improved survival were localized disease (hazard ratio [HR], 18.1; 95% confidence interval [CI], 16.6-19.6), nephrectomy (HR, 2.87; 95% CI, 2.68-3.08), and clear cell histologic type (HR, 1.33; 95% CI, 1.22-1.44). Conclusions: In this analysis of a large RCC registry, there was an apparent increase in crude OS and CSS in the post-cytokine era compared with the cytokine era. Insufficient follow-up time in the post-cytokine era and a higher proportion of localized disease in that era confound the possibility of benefit derived from targeted therapies. Longer follow-up for patients treated in the post-cytokine era is necessary for a more robust comparison of long-term OS.

Original languageEnglish (US)
Pages (from-to)93-98
Number of pages6
JournalClinical Genitourinary Cancer
Volume10
Issue number2
DOIs
StatePublished - Jun 2012

Fingerprint

Renal Cell Carcinoma
Registries
Cytokines
Survival
Confidence Intervals
Nephrectomy
Cell- and Tissue-Based Therapy
Proportional Hazards Models
Sex Characteristics
Interferons
Population
Interleukin-2
Neoplasms
Multivariate Analysis
Therapeutics

Keywords

  • Cytokines
  • Distant disease
  • Regional disease
  • Renal cell cancer
  • Targeted agents

ASJC Scopus subject areas

  • Oncology
  • Urology

Cite this

Epidemiologic trends in renal cell carcinoma in the cytokine and post-cytokine eras : A registry analysis of 28,252 patients. / Shek, Derek; Tomlinson, Benjamin; Brown, Monica; Brunson, Ann; Pan, Chong-Xian; Lara, Primo N.

In: Clinical Genitourinary Cancer, Vol. 10, No. 2, 06.2012, p. 93-98.

Research output: Contribution to journalArticle

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title = "Epidemiologic trends in renal cell carcinoma in the cytokine and post-cytokine eras: A registry analysis of 28,252 patients",
abstract = "Background: Before 2004, advanced renal cell cancer (RCC) therapy consisted primarily of cytokines such as interferon and/or interleukin-2. Subsequently, randomized trials of targeted therapies have shown a survival benefit, leading to the approval of several new agents since 2004. Whether the survival benefit seen in highly selected patients accrued to these trials has already translated to the general RCC patient population is unclear. To explore this, a large RCC patient registry was evaluated for changes in outcome between the cytokine (1998-2003) and post-cytokine (2004-2007) eras. Methods: Data from the California Cancer Registry (CCR), a population-based cancer surveillance system, was used to retrospectively analyze 28,252 patients with RCC diagnosed between 1998 and 2007. Inter-era differences in clinical variables - including year of diagnosis, histologic characteristics, age, sex, race, stage, nephrectomy status, overall survival (OS), and cause-specific survival (CSS) - were assessed. Univariate and multivariate Cox models were used. Results: Crude 3-year OS (68.2{\%} vs. 74.6{\%}; 2P <.001) and CSS (78.1{\%} vs. 82.3{\%}; 2P <.001) were significantly higher in the post-cytokine era. In multivariate analysis, the 3 strongest predictors for improved survival were localized disease (hazard ratio [HR], 18.1; 95{\%} confidence interval [CI], 16.6-19.6), nephrectomy (HR, 2.87; 95{\%} CI, 2.68-3.08), and clear cell histologic type (HR, 1.33; 95{\%} CI, 1.22-1.44). Conclusions: In this analysis of a large RCC registry, there was an apparent increase in crude OS and CSS in the post-cytokine era compared with the cytokine era. Insufficient follow-up time in the post-cytokine era and a higher proportion of localized disease in that era confound the possibility of benefit derived from targeted therapies. Longer follow-up for patients treated in the post-cytokine era is necessary for a more robust comparison of long-term OS.",
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T2 - A registry analysis of 28,252 patients

AU - Shek, Derek

AU - Tomlinson, Benjamin

AU - Brown, Monica

AU - Brunson, Ann

AU - Pan, Chong-Xian

AU - Lara, Primo N

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N2 - Background: Before 2004, advanced renal cell cancer (RCC) therapy consisted primarily of cytokines such as interferon and/or interleukin-2. Subsequently, randomized trials of targeted therapies have shown a survival benefit, leading to the approval of several new agents since 2004. Whether the survival benefit seen in highly selected patients accrued to these trials has already translated to the general RCC patient population is unclear. To explore this, a large RCC patient registry was evaluated for changes in outcome between the cytokine (1998-2003) and post-cytokine (2004-2007) eras. Methods: Data from the California Cancer Registry (CCR), a population-based cancer surveillance system, was used to retrospectively analyze 28,252 patients with RCC diagnosed between 1998 and 2007. Inter-era differences in clinical variables - including year of diagnosis, histologic characteristics, age, sex, race, stage, nephrectomy status, overall survival (OS), and cause-specific survival (CSS) - were assessed. Univariate and multivariate Cox models were used. Results: Crude 3-year OS (68.2% vs. 74.6%; 2P <.001) and CSS (78.1% vs. 82.3%; 2P <.001) were significantly higher in the post-cytokine era. In multivariate analysis, the 3 strongest predictors for improved survival were localized disease (hazard ratio [HR], 18.1; 95% confidence interval [CI], 16.6-19.6), nephrectomy (HR, 2.87; 95% CI, 2.68-3.08), and clear cell histologic type (HR, 1.33; 95% CI, 1.22-1.44). Conclusions: In this analysis of a large RCC registry, there was an apparent increase in crude OS and CSS in the post-cytokine era compared with the cytokine era. Insufficient follow-up time in the post-cytokine era and a higher proportion of localized disease in that era confound the possibility of benefit derived from targeted therapies. Longer follow-up for patients treated in the post-cytokine era is necessary for a more robust comparison of long-term OS.

AB - Background: Before 2004, advanced renal cell cancer (RCC) therapy consisted primarily of cytokines such as interferon and/or interleukin-2. Subsequently, randomized trials of targeted therapies have shown a survival benefit, leading to the approval of several new agents since 2004. Whether the survival benefit seen in highly selected patients accrued to these trials has already translated to the general RCC patient population is unclear. To explore this, a large RCC patient registry was evaluated for changes in outcome between the cytokine (1998-2003) and post-cytokine (2004-2007) eras. Methods: Data from the California Cancer Registry (CCR), a population-based cancer surveillance system, was used to retrospectively analyze 28,252 patients with RCC diagnosed between 1998 and 2007. Inter-era differences in clinical variables - including year of diagnosis, histologic characteristics, age, sex, race, stage, nephrectomy status, overall survival (OS), and cause-specific survival (CSS) - were assessed. Univariate and multivariate Cox models were used. Results: Crude 3-year OS (68.2% vs. 74.6%; 2P <.001) and CSS (78.1% vs. 82.3%; 2P <.001) were significantly higher in the post-cytokine era. In multivariate analysis, the 3 strongest predictors for improved survival were localized disease (hazard ratio [HR], 18.1; 95% confidence interval [CI], 16.6-19.6), nephrectomy (HR, 2.87; 95% CI, 2.68-3.08), and clear cell histologic type (HR, 1.33; 95% CI, 1.22-1.44). Conclusions: In this analysis of a large RCC registry, there was an apparent increase in crude OS and CSS in the post-cytokine era compared with the cytokine era. Insufficient follow-up time in the post-cytokine era and a higher proportion of localized disease in that era confound the possibility of benefit derived from targeted therapies. Longer follow-up for patients treated in the post-cytokine era is necessary for a more robust comparison of long-term OS.

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KW - Targeted agents

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