A qualitative framework of non-selection factors for cytoreductive nephrectomy View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2021-03-29

AUTHORS

Andrew W. Silagy, Kyrollis Attalla, Renzo G. Dinatale, Kate L. Weiss, Stanley Weng, Roy Mano, Skylar Iosepovici, Julian Marcon, Ed Reznik, Ritesh R. Kotecha, Robert J. Motzer, Martin H. Voss, Jonathan A. Coleman, A. Ari Hakimi, Paul Russo

ABSTRACT

PurposeCytoreductive nephrectomy (CN) benefits a subset of patients with metastatic renal cell carcinoma (mRCC), however proper patient selection remains complex and controversial. We aim to characterize urologists’ reasons for not undertaking a CN at a quaternary cancer center.MethodsConsecutive patients with mRCC referred to MSKCC urologists for consideration of CN between 2009 and 2019 were included. Baseline clinicopathologic characteristics were used to compare patients selected or rejected for CN. The reasons cited for not operating and the alternative management strategies recommended were extrapolated. Using an iterative thematic analysis, a framework of reasons for rejecting CN was designed. Kaplan–Meier estimates tested for associations between the reasons for not undertaking a CN and overall survival (OS).ResultsOf 297 patients with biopsy-proven mRCC, 217 (73%) underwent CN and 80 (27%) did not. Median follow-up of patients alive at data cut-off was 27.3 months. Non-operative patients were older (p = 0.014), had more sites of metastases (p = 0.008), harbored non-clear cell histology (p = 0.014) and reduced performance status (p < 0.001). The framework comprised seven distinct themes for recommending non-operative management: two patient-fitness considerations and five oncological considerations. These considerations were associated with OS; four of the oncological factors conferred a median OS of less than 12 months (p < 0.001).ConclusionWe developed a framework of criteria by which patients were deemed unsuitable candidates for CN. These new insights provide a novel perspective on surgical selection, could potentially be applicable to other malignancies and possibly have prognostic implications. More... »

PAGES

3359-3365

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00345-021-03650-4

DOI

http://dx.doi.org/10.1007/s00345-021-03650-4

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1136748018

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/33779820


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18 schema:description PurposeCytoreductive nephrectomy (CN) benefits a subset of patients with metastatic renal cell carcinoma (mRCC), however proper patient selection remains complex and controversial. We aim to characterize urologists’ reasons for not undertaking a CN at a quaternary cancer center.MethodsConsecutive patients with mRCC referred to MSKCC urologists for consideration of CN between 2009 and 2019 were included. Baseline clinicopathologic characteristics were used to compare patients selected or rejected for CN. The reasons cited for not operating and the alternative management strategies recommended were extrapolated. Using an iterative thematic analysis, a framework of reasons for rejecting CN was designed. Kaplan–Meier estimates tested for associations between the reasons for not undertaking a CN and overall survival (OS).ResultsOf 297 patients with biopsy-proven mRCC, 217 (73%) underwent CN and 80 (27%) did not. Median follow-up of patients alive at data cut-off was 27.3 months. Non-operative patients were older (p = 0.014), had more sites of metastases (p = 0.008), harbored non-clear cell histology (p = 0.014) and reduced performance status (p < 0.001). The framework comprised seven distinct themes for recommending non-operative management: two patient-fitness considerations and five oncological considerations. These considerations were associated with OS; four of the oncological factors conferred a median OS of less than 12 months (p < 0.001).ConclusionWe developed a framework of criteria by which patients were deemed unsuitable candidates for CN. These new insights provide a novel perspective on surgical selection, could potentially be applicable to other malignancies and possibly have prognostic implications.
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72 performance status
73 perspective
74 prognostic implications
75 proper patient selection
76 qualitative framework
77 quaternary cancer centre
78 reasons
79 renal cell carcinoma
80 selection
81 sites
82 status
83 strategies
84 subset
85 subset of patients
86 surgical selection
87 survival
88 thematic analysis
89 themes
90 unsuitable candidates
91 urologists
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