免疫联合治疗时代原发性转移性肾细胞癌管理中的地理差异。
Geographical differences in the management of metastatic de novo renal cell carcinoma in the era of immune-combinations.
发表日期：2023 Aug
作者：
Camillo Porta, Aristotelis Bamias, Roubini Zakopoulou, Zin W Myint, Nicolò Cavasin, Roberto Iacovelli, Martin Pichler, Jindrich Kopecky, Jakub Kucharz, Mimma Rizzo, Luca Galli, Thomas Büttner, Ugo DE Giorgi, Ravindran Kanesvaran, Ondřej Fiala, Enrique Grande, Paolo A Zucali, Ray M Kopp, Giuseppe Fornarini, Maria T Bourlon, Sarah Scagliarini, Javier Molina-Cerrillo, Gaetano Aurilio, Marc R Matrana, Renate Pichler, Carlo Cattrini, Tomáš Büchler, Francesco Massari, Veronica Mollica, Emmanuel Seront, Fabio Calabrò, Alvaro Pinto, Rossana Berardi, Anca Zgura, Giulia Mammone, Jawaher Ansari, Francesco Atzori, Rita Chiari, Orazio Caffo, Giuseppe Procopio, Kaisa Sunela, Maria Bassanelli, Cinzia Ortega, Francesco Grillone, Johannes Landmesser, Sara Merler, Carlo Messina, Zsófia Küronya, Alessandra Mosca, Dipen Bhuva, Daniele Santini, Nuno Vau, Franco Morelli, Lorena Incorvaia, Sara E Rebuzzi, Giandomenico Roviello, Andrey Soares, Ignacio O Zabalza, Alessandro Rizzo, Renato Bisonni, Francesco Pierantoni, Giulia Sorgentoni, Fernando S Monteiro, Nicola Battelli, Sebastiano Buti, Matteo Santoni
来源：
CLINICAL PHARMACOLOGY & THERAPEUTICS
摘要：
转移性肾细胞癌（mRCC）的前期治疗由于免疫组合疗法的引入而发生了革命性变化。细胞减毒性肾切除术（CN）在这些患者中的作用仍存在争议。ARON-1研究（NCT05287464）旨在全面分析接受一线免疫肿瘤学组合疗法的mRCC患者的真实世界数据。此次亚分析以三个地理区域（西欧、东欧、美洲/亚洲）前期或延迟进行肾部分切除或全切的作用为重点。我们在19个国家的55个中心进行了一项多中心回顾性观察性研究，纳入了接受一线免疫组合疗法的mRCC患者。从ARON-1数据集的1152名患者中，我们选择了651名原发性mRCC患者。255名患者（39%）接受了CN，其中14%为部分切除，86%为全切；396名患者（61%）在未进行肾切除的情况下接受了一线免疫组合疗法。从原发性mRCC诊断开始的中位总生存期（OS）在CN亚组为41.6个月，未达到（NR）；而在无CN亚组为24.0个月（P<0.001）。从一线治疗开始，接受CN的患者的中位OS为NR，而未接受CN的亚组为22.4个月（P<0.001）。与未进行CN的患者相比，接受CN的患者在所有三个地理区域中的OS更长。尽管在ARON-1项目参与的不同癌症中心中，CN的比例和选择一线免疫组合疗法类型存在差异，但在患者预后方面似乎不存在明显差异。
The upfront treatment of metastatic renal cell carcinoma (mRCC) has been revolutionized by the introduction of immune-based combinations. The role of cytoreductive nephrectomy (CN) in these patients is still debated. The ARON-1 study (NCT05287464) was designed to globally analyze real-world data of mRCC patients receiving first-line immuno-oncology combinations. This sub-analysis is focused on the role of upfront or delayed partial or radical CN in three geographical areas (Western Europe, Eastern Europe, America/Asia).We conducted a multicenter retrospective observational study in mRCC patients treated with first-line immune combinations from 55 centers in 19 countries. From 1152 patients in the ARON-1 dataset, we selected 651 patients with de novo mRCC. 255 patients (39%) had undergone CN, partial in 14% and radical in 86% of cases; 396 patients (61%) received first-line immune-combinations without previous nephrectomy.Median overall survival (OS) from the diagnosis of de novo mRCC was 41.6 months and not reached (NR) in the CN subgroup and 24.0 months in the no CN subgroup, respectively (P<0.001). Median OS from the start of first-line therapy was NR in patients who underwent CN and 22.4 months in the no CN subgroup (P<0.001). Patients who underwent CN reported longer OS compared to no CN in all the three geographical areas.No significant differences in terms of patients' outcome seem to clearly emerge, even if the rate CN and the choice of the type of first-line immune-based combination varies across the different Cancer Centers participating in the ARON-1 project.