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Huang JX, Zhang X, Tang M, Zhang Q, Deng L, Song CH, Li W, Yang M, Shi HP, Cong MH. Association between a novel nutrition-inflammation prognostic grading system and overall survival in hospitalized adults with cancer: A retrospective cohort study. JPEN J Parenter Enteral Nutr 2024; 48:108-119. [PMID: 37855392 DOI: 10.1002/jpen.2565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/31/2023] [Accepted: 10/07/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Malnutrition and increased systemic inflammatory responses are highly prevalent in patients with cancer and they have a negative effect on prognosis. We aimed to develop a nutrition-inflammation prognostic grading system (NIPGS) for patients with cancer, which incorporates the Nutritional Risk Screening 2002 (NRS 2002) and C-reactive protein (CRP) levels. METHODS This multicenter retrospective cohort study totally included 6891 patients diagnosed with cancer. A 4 × 4 matrix incorporating the four NRS 2002 categories within each of the four CRP categories was constructed. Groups with approximate hazard ratios (HRs) were clustered into one grade. The NIPGS consists of four grades, with the survival rate gradually decreasing from Grades 1 to 4. The primary outcome was overall survival (OS) and comprehensive survival analyses were performed. RESULTS During a median follow-up of 18.70 months, 2818 death cases occurred. Kaplan-Meier curve showed the survival rate decreased from Grades 1 to 4 of NIPGS (P < 0.001). The NIPGS was an independent risk factor associated with OS adjusting for confounders, with HRs increasing from 1.22 (95% confidence interval [CI], 1.09-1.36; P < 0.001) in Grade 2, 1.58 (95% CI, 1.39-1.80; P < 0.001) in Grade 3 to 1.92 (95% CI, 1.73-2.13; P < 0.001) in Grade 4. A high NIPGS grade was also associated with an increased risk of short-term mortality, poor quality of life, and longer hospital stay and expenses. Two internal validation cohorts confirmed the results of our study. CONCLUSION The NIPGS could be an effective prognostic tool for patients with cancer.
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Affiliation(s)
- Jia-Xin Huang
- Department of Comprehensive Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Cancer Center of the First Hospital of Jilin University, Changchun, China
| | - Xi Zhang
- Department of Comprehensive Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China
| | - Meng Tang
- Department of Comprehensive Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China
| | - Qi Zhang
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China
- Department of Gastrointestinal Surgery, Zhejiang Cancer Hospital, Hangzhou, China
| | - Li Deng
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China
- Department of Gastrointestinal Surgery and Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Chun-Hua Song
- Department of Epidemiology, Zhengzhou University, Zhengzhou, China
| | - Wei Li
- Cancer Center of the First Hospital of Jilin University, Changchun, China
| | - Min Yang
- Department of Comprehensive Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Han-Ping Shi
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China
- Department of Gastrointestinal Surgery and Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Ming-Hua Cong
- Department of Comprehensive Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Ohba K, Monji K, Osawa T, Yamana K, Yasuda Y, Tanaka H, Nakagawa Y, Fukuyama T, Matsubara N, Uemura H, Sakai H, Eto M. Comprehensive investigation of clinicopathological and immunological features to determine prognostic impact in metastatic renal cell carcinoma: The JEWEL study. Int J Urol 2023; 30:977-984. [PMID: 37434386 DOI: 10.1111/iju.15244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 06/20/2023] [Indexed: 07/13/2023]
Abstract
OBJECTIVES Current prognostic models for metastatic renal cell carcinoma (mRCC) are likely inaccurate due to recent treatment advances and improved survival outcomes. The JEWEL study used a data set from patients who received tyrosine kinase inhibitors (TKIs) to explore the prognostic impact of the tumor immune environment in the absence of immune checkpoint inhibitor intervention. METHODS The primary analysis population comprised 569 of the 770 Japanese patients enrolled in the ARCHERY study who received first-line TKIs. Multivariable Cox proportional hazard models were used to identify factors associated with the primary (overall survival [OS]) and secondary outcomes (treatment duration) using 34 candidate explanatory variables. RESULTS Median OS was 34.1 months (95% CI, 30.4-37.6) in the primary analysis population. A considerable negative prognostic impact (descriptive p ≤ 0.0005) on OS was seen with lactate dehydrogenase (LDH) >1.5 × upper limit of normal (adjusted HR [aHR], 3.30; 95% CI, 2.19-4.98), Eastern Cooperative Oncology Group performance status (ECOG PS) ≥2 (aHR, 2.14; 95% CI, 1.56-2.94), World Health Organization (WHO)/International Society of Urological Pathology (ISUP) Grade 4 (aHR, 1.89; 95% CI, 1.43-2.51), C-reactive protein (CRP) level ≥0.3 (aHR, 1.78; 95% CI, 1.40-2.26), and age ≥75 years (aHR, 1.65; 95% CI, 1.24-2.18) in the multivariable analysis. PD-L1 and immunophenotype affected OS in univariable analyses but were not selected in the multivariable model as explanatory variables. CONCLUSIONS JEWEL identified sex, age, ECOG PS, liver and bone metastases, CRP levels, WHO/ISUP grade, LDH, and albumin levels as key prognostic factors for OS after first-line TKI therapy for mRCC.
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Affiliation(s)
- Kojiro Ohba
- Department of Urology and Renal Transplantation, Nagasaki University Hospital, Nagasaki, Japan
| | - Keisuke Monji
- Department of Urology, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Takahiro Osawa
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo-shi, Hokkaido, Japan
| | - Kazutoshi Yamana
- Departments of Urology and Molecular Urology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yosuke Yasuda
- Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Hajime Tanaka
- Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Yuki Nakagawa
- Clinical Development Division, Chugai Pharmaceutical Co, Ltd, Tokyo, Japan
| | - Tamaki Fukuyama
- Medical Affairs Division, Chugai Pharmaceutical Co, Ltd, Tokyo, Japan
| | - Nobuaki Matsubara
- Department of Medical Urology, National Cancer Center Hospital East, Chiba, Japan
| | - Hirotsugu Uemura
- Department of Urology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Hideki Sakai
- Department of Urology and Renal Transplantation, Nagasaki University Hospital, Nagasaki, Japan
| | - Masatoshi Eto
- Department of Urology, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
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Outcomes According to MSKCC Risk Score with Focus on the Intermediate-Risk Group in Metastatic Renal Cell Carcinoma Patients Treated with First-Line Sunitinib: A Retrospective Analysis of 2390 Patients. Cancers (Basel) 2020; 12:cancers12040808. [PMID: 32230921 PMCID: PMC7225945 DOI: 10.3390/cancers12040808] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 03/16/2020] [Accepted: 03/25/2020] [Indexed: 01/01/2023] Open
Abstract
Background: The Memorial Sloan–Kettering Cancer Center (MSKCC) prognostic model has been widely used for the prediction of the outcome of metastatic renal cell carcinoma (mRCC) patients treated with systemic therapies, however, data from large studies are limited. This study aimed at the evaluation of the impact of the MSKCC score on the outcomes in mRCC patients treated with first-line sunitinib, with a focus on the intermediate-risk group. Methods: Clinical data from 2390 mRCC patients were analysed retrospectively. Progression-free survival (PFS), overall survival (OS), and objective response rate (ORR) were analysed according to the MSKCC risk score. Results: ORR, median PFS, and OS for patients with one risk factor were 26.7%, 10.1, and 28.2 months versus 18.7%, 6.2, and 16.2 months, respectively, for those with two risk factors (ORR: p = 0.001, PFS: p < 0.001, OS: p < 0.001). ORR, median PFS, and OS were 33.0%, 17.0, and 44.7 months versus 24.1%, 9.0, and 24.1 months versus 13.4%, 4.5, and 9.5 months in the favourable-, intermediate-, and poor-risk groups, respectively (ORR: p < 0.001, PFS: p < 0.001, OS: p < 0.001). Conclusions: The results of the present retrospective study demonstrate the suitability of the MSKCC model in mRCC patients treated with first-line sunitinib and suggest different outcomes between patients with one or two risk factors.
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4
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Vázquez Estévez S, Anido U, Lázaro M, Fernández O, Fernández Núñez N, de Dios Álvarez N, Varela V, Campos Balea B, Agraso S, Areses MC, Iglesias L, Blanco M, Maciá S, Anton Aparicio LM. A new scenario in metastatic renal cell carcinoma: a SOG-GU consensus. Clin Transl Oncol 2020; 22:1565-1579. [PMID: 32062835 DOI: 10.1007/s12094-020-02300-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 01/09/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND This article describes and compares approved targeted therapies and the newer immunotherapy agents. MATERIALS AND METHODS This article especially performs an in-depth review of currently available data for tivozanib, explaining its mechanism of action, its safety profile and its role as an efficacy drug in the management of renal cancer. RESULTS Despite the fact that the treatment of advanced RCC has been dramatically modified in recent years, durable remissions are scarce and it remains a lethal disease. For first- and second-line therapy, there is now growing evidence to guide the selection of the appropriate treatment. CONCLUSIONS Several TKIs are standard of care at different settings. Among those approved TKIs, tivozanib has similar efficacy than others with a better safety profile. The use of prognostic factors is critical to the selection of optimal therapy.
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Affiliation(s)
- S Vázquez Estévez
- Medical Oncology Department, Hospital Universitario Lucus Augusti (Lugo), Dr. Ulises Romero, s/n, 27003, Lugo, Spain.
| | - U Anido
- Medical Oncology Department, Complejo Hospitalario Universitario Santiago de Compostela, Trav. da Choupana, s/n, 15702, Santiago de Compostela, Spain
| | - M Lázaro
- Medical Oncology Department, Hospital Álvaro Cunqueiro, Camiño dos Cañotais 44, 36312, Vigo, Spain
| | - O Fernández
- Medical Oncology Department, Complexo Hospitalario Universitario de Ourense, Ramón Puga Noguerol, 54, 32005, Ourense, Spain
| | - N Fernández Núñez
- Medical Oncology Department, Hospital Universitario Lucus Augusti (Lugo), Dr. Ulises Romero, s/n, 27003, Lugo, Spain
| | - N de Dios Álvarez
- Medical Oncology Department, Hospital Álvaro Cunqueiro, Camiño dos Cañotais 44, 36312, Vigo, Spain
| | - V Varela
- Medical Oncology Department, Complejo Hospitalario Universitario Santiago de Compostela, Trav. da Choupana, s/n, 15702, Santiago de Compostela, Spain
| | - B Campos Balea
- Medical Oncology Department, Hospital Universitario Lucus Augusti (Lugo), Dr. Ulises Romero, s/n, 27003, Lugo, Spain
| | - S Agraso
- Medical Oncology Department, Hospital Álvaro Cunqueiro, Camiño dos Cañotais 44, 36312, Vigo, Spain
| | - M C Areses
- Medical Oncology Department, Complexo Hospitalario Universitario de Ourense, Ramón Puga Noguerol, 54, 32005, Ourense, Spain
| | - L Iglesias
- Medical Oncology Department, Complexo Hospitalario Universitario de Ourense, Ramón Puga Noguerol, 54, 32005, Ourense, Spain
| | - M Blanco
- Medical Oncology Department, Complejo Hospitalario Universitario Santiago de Compostela, Trav. da Choupana, s/n, 15702, Santiago de Compostela, Spain
| | - S Maciá
- Oncology Medical Department, Pivotal, Calle Gobelas, no 19, 28023, Madrid, Spain
| | - L M Anton Aparicio
- Medical Oncology Department, Complejo Hospitalario Universitario A Coruña, As Xubias, 84, 15006, A Coruña, Spain
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Harada K, Nozawa M, Uemura M, Tatsugami K, Osawa T, Yamana K, Kimura G, Fujisawa M, Nonomura N, Eto M, Shinohara N, Tomita Y, Kondo Y, Ochi K, Anazawa Y, Uemura H. Treatment patterns and outcomes in patients with unresectable or metastatic renal cell carcinoma in Japan. Int J Urol 2018; 26:202-210. [DOI: 10.1111/iju.13830] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 09/13/2018] [Indexed: 01/09/2023]
Affiliation(s)
- Kenichi Harada
- Division of Urology Department of Surgery Related Kobe University Graduate School of Medicine Kobe Japan
| | - Masahiro Nozawa
- Department of Urology Kindai University Faculty of Medicine Osaka Japan
| | - Motohide Uemura
- Department of Urology Osaka University Graduate School of Medicine Osaka Japan
| | - Katsunori Tatsugami
- Department of Urology Graduate School of Medical Sciences Kyushu University Fukuoka Japan
| | | | - Kazutoshi Yamana
- Department of Urology, Molecular Oncology Graduate School of Medical and Dental Sciences Niigata University Niigata Japan
| | - Go Kimura
- Department of Urology Nippon Medical School Tokyo Japan
| | - Masato Fujisawa
- Division of Urology Department of Surgery Related Kobe University Graduate School of Medicine Kobe Japan
| | - Norio Nonomura
- Department of Urology Osaka University Graduate School of Medicine Osaka Japan
| | - Masatoshi Eto
- Department of Urology Graduate School of Medical Sciences Kyushu University Fukuoka Japan
| | | | - Yoshihiko Tomita
- Department of Urology, Molecular Oncology Graduate School of Medical and Dental Sciences Niigata University Niigata Japan
| | | | | | | | - Hirotsugu Uemura
- Department of Urology Kindai University Faculty of Medicine Osaka Japan
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Neutrophil-to-lymphocyte Ratio, Platelet-to-lymphocyte Ratio, and C-reactive Protein as New and Simple Prognostic Factors in Patients With Metastatic Renal Cell Cancer Treated With Tyrosine Kinase Inhibitors: A Systemic Review and Meta-analysis. Clin Genitourin Cancer 2018; 16:e685-e693. [PMID: 29454639 DOI: 10.1016/j.clgc.2018.01.010] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 01/08/2018] [Accepted: 01/16/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Inflammation plays a crucial role in cancer development. In this study, we evaluate the prognostic values of systemic inflammation markers such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and C-reactive protein (CRP) for the progression-free survival and overall survival in patients with metastatic renal cell carcinoma treated with tyrosine kinase inhibitors. MATERIALS AND METHODS PubMed and the Cochrane Library databases were searched for published studies on the effect of NLR, PLR, and CRP in patients with metastatic renal cell carcinoma treated with tyrosine kinase inhibitors. RESULTS In the meta-analysis, NLR (hazard ratio [HR], 2.01; 95% confidence interval [CI], 1.27-3.18; P = .003) and PLR (HR, 6.96; 95% CI, 5.04-9.62; P < .001) had a significant influence on progression-free survival, whereas all considered proinflammatory markers had a significant impact on overall survival: NLR (HR, 2.14; 95% CI, 1.67-2.73; P < .001), PLR (HR, 14.67; 95% CI, 11.10-19.57; P < .001), and CRP (HR, 1.96; 95% CI, 1.26-3.05; P = .003). CONCLUSIONS Inflammation markers such as NLR, PLR, and CRP are predictors of clinical outcome and could provide additional information to individualize treatment.
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Wang Z, Peng S, Wang A, Xie H, Guo L, Jiang N, Niu Y. C-reactive protein is a predictor of prognosis in renal cell carcinoma patients receiving tyrosine kinase inhibitors: A meta-analysis. Clin Chim Acta 2017; 475:178-187. [PMID: 29080691 DOI: 10.1016/j.cca.2017.10.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 10/20/2017] [Accepted: 10/22/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND The prognostic value of C-reactive protein (CRP) in metastatic renal cell carcinoma (RCC) patients receiving tyrosine kinase inhibitors (TKIs) has been investigated in previous studies; however, the results remain inconclusive. This study investigated the prognostic value of pretreatment CRP in patients with metastatic RCC treated with TKIs. METHODS PubMed, Embase, Web of Science, and Cochrane databases were searched for studies investigating the relationships between pretreatment CRP and prognosis in patients with metastatic RCC. Hazard ratios (HRs) for overall survival (OS) and progression-free survival (PFS) were extracted from eligible studies. Heterogeneity was assessed using the I2 value. The fixed-effects model was used if there was no evidence of heterogeneity; otherwise, the random-effects model was used. Publication bias was evaluated using Begg's funnel plots and Egger's regression test. RESULTS A total of 1199 patients from nine studies were included in the analysis. The results showed that an elevated CRP level was an effective prognostic marker of both OS (pooled HR=2.87, 95% confidence interval [CI]: 2.34-3.54, p<0.001) and PFS (pooled HR=2.39, 95% CI: 1.75-3.26, p<0.001). Subgroup analysis revealed that an elevated CRP level significantly predicted poor OS and PFS in studies conducted in Japan (OS, pooled HR=3.03, 95% CI: 2.29-4.01, p<0.001; PFS, pooled HR=3.6, 95% CI: 1.62-8.0, p=0.002), and in cut-off value of CRP <0.8 (OS, pooled HR=2.93, 95% CI: 2.21-3.88, p<0.001; PFS, pooled HR=2.57, 95% CI: 1.82-3.65, p<0.001). CONCLUSIONS This study suggests that an elevated CRP level is correlated with poor prognosis in patients with metastatic RCC receiving TKIs treatment.
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Affiliation(s)
- Zhun Wang
- Department of Urology, Tianjin Institute of Urology, The second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Shuanghe Peng
- Department of Urology, Tianjin Institute of Urology, The second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Aixiang Wang
- Department of Urology, Tianjin Institute of Urology, The second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Hui Xie
- Department of Urology, Tianjin Institute of Urology, The second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Linpei Guo
- Department of Urology, Tianjin Institute of Urology, The second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Ning Jiang
- Department of Urology, Tianjin Institute of Urology, The second Hospital of Tianjin Medical University, Tianjin 300211, China.
| | - Yuanjie Niu
- Department of Urology, Tianjin Institute of Urology, The second Hospital of Tianjin Medical University, Tianjin 300211, China.
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Omae K, Fukuma S, Ikenoue T, Kondo T, Takagi T, Ishihara H, Tanabe K, Fukuhara S. Effect of ABO blood type on the outcomes of patients with metastatic renal cell carcinoma treated with first-line tyrosine kinase inhibitors. Urol Oncol 2017. [PMID: 28624136 DOI: 10.1016/j.urolonc.2017.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To assess the effect of blood type on survival outcomes and adverse events (AEs) in patients treated with tyrosine kinase inhibitors (TKIs) for metastatic renal cell carcinoma (mRCC). MATERIALS AND METHODS Patients who received TKIs as first-line therapy for mRCC between 2008 and 2015 at our hospital were included in the study (n = 136). Patients were divided into 2 groups based on their blood type as O and non-O. Survival outcomes and AEs were compared according to blood type. Cox regression models were used for univariate and multivariate survival analyses. RESULTS Of the 136 patients, 34 (25%) and 102 (75%) had O and non-O blood types, respectively. Blood type O was associated with an increased number of disease sites. There were no differences between the 2 groups with respect to other baseline characteristics. The progression-free survival in patients with O and non-O blood types was 12.1 and 11.6 months, respectively; the overall survival was 34.4 and 24.8 months, respectively. On univariate and multivariate analyses, the ABO blood type was not a significant prognostic factor for progression-free survival or overall survival. Furthermore, the incidences of serious AEs were similar in the 2 blood groups. CONCLUSIONS ABO blood type was not associated with survival outcomes or incidences of serious AEs in mRCC patients treated with TKIs. However, blood type O may be associated with an increased number of disease sites.
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Affiliation(s)
- Kenji Omae
- Department of Healthcare Epidemiology, Kyoto University School of Public Health, Kyoto, Japan; Fukushima Medical University, Center for Innovative Research for Communities and Clinical Excellence, Fukushima City, Fukushima, Japan; Department of Urology, Tokyo Women׳s Medical University, Tokyo, Japan
| | - Shingo Fukuma
- Department of Healthcare Epidemiology, Kyoto University School of Public Health, Kyoto, Japan; Fukushima Medical University, Center for Innovative Research for Communities and Clinical Excellence, Fukushima City, Fukushima, Japan
| | - Tatsuyoshi Ikenoue
- Department of Healthcare Epidemiology, Kyoto University School of Public Health, Kyoto, Japan
| | - Tsunenori Kondo
- Department of Urology, Tokyo Women׳s Medical University, Tokyo, Japan
| | - Toshio Takagi
- Department of Urology, Tokyo Women׳s Medical University, Tokyo, Japan
| | - Hiroki Ishihara
- Department of Urology, Tokyo Women׳s Medical University, Tokyo, Japan
| | - Kazunari Tanabe
- Department of Urology, Tokyo Women׳s Medical University, Tokyo, Japan.
| | - Shunichi Fukuhara
- Department of Healthcare Epidemiology, Kyoto University School of Public Health, Kyoto, Japan; Fukushima Medical University, Center for Innovative Research for Communities and Clinical Excellence, Fukushima City, Fukushima, Japan
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Oya M, Tomita Y, Fukasawa S, Shinohara N, Habuchi T, Rini BI, Fujii Y, Kamei Y, Umeyama Y, Bair AH, Uemura H. Overall survival of first-line axitinib in metastatic renal cell carcinoma: Japanese subgroup analysis from phase II study. Cancer Sci 2017; 108:1231-1239. [PMID: 28267243 PMCID: PMC5480076 DOI: 10.1111/cas.13232] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 02/27/2017] [Accepted: 03/02/2017] [Indexed: 12/03/2022] Open
Abstract
Subgroup analyses of a randomized global phase II study of axitinib showed objective response rate of 66% and median progression-free survival of 27.6 months in treatment-naïve Japanese patients with metastatic renal cell carcinoma (RCC). This analysis evaluated overall survival (OS) and safety in 44 Japanese patients and compared the results with 169 non-Japanese patients. In addition, baseline characteristics for predictive factors that may influence OS in first-line metastatic RCC were explored in all patients using a Cox proportional hazard model. With median follow-up of 33 months, fewer than half (16 of 44) of the Japanese patients had died and median OS was not reached (95% confidence interval [CI], 38.8 months-not estimable), whereas 107 of 169 (63%) non-Japanese patients had died and median OS was 33.9 months (95% CI, 28.9-42.7). Estimated 1-year, 2-year and 3-year survival probability (95% CI) was 86.4% (76.2-96.5), 75.0% (62.2-87.8) and 68.2% (54.4-81.9), respectively, in Japanese patients, and was higher than that in non-Japanese patients (75.1% [68.4-81.8], 62.1% [54.5-69.7] and 47.2% [39.3-55.1], respectively). The updated safety analysis did not reveal any new adverse events of concern among Japanese or non-Japanese patients. The multivariate analysis identified that lower baseline Eastern Cooperative Oncology Group performance status, lower baseline tumor burden, and longer time from histopathological diagnosis to treatment were significant positive predictors of OS. The current analysis confirmed the clinical activity of axitinib in treatment-naïve Japanese patients with metastatic RCC, with an acceptable toxicity profile.
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Affiliation(s)
- Mototsugu Oya
- Department of UrologyKeio University School of MedicineTokyoJapan
| | - Yoshihiko Tomita
- Department of UrologyYamagata University Faculty of MedicineYamagataJapan
- Present address: Niigata University Graduate School of Medical and Dental SciencesNiigataJapan
| | - Satoshi Fukasawa
- Prostate Center and Division of UrologyChiba Cancer CenterChibaJapan
| | - Nobuo Shinohara
- Department of UrologyHokkaido University Graduate School of MedicineHokkaidoJapan
| | - Tomonori Habuchi
- Department of UrologyAkita University School of MedicineAkitaJapan
| | - Brian I. Rini
- Department of Solid Tumor OncologyCleveland ClinicTaussig Cancer InstituteClevelandOhioUSA
| | | | | | | | | | - Hirotsugu Uemura
- Department of UrologyKindai University Faculty of MedicineOsakaJapan
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10
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Yoshimura K, Uemura H. Pharmacotherapies for renal cell carcinoma in Japan. Int J Urol 2015; 23:194-202. [PMID: 26663209 DOI: 10.1111/iju.13008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 10/12/2015] [Indexed: 01/10/2023]
Abstract
The standard treatment for advanced renal cell carcinoma has changed dramatically in the past decade, from cytokine therapy to targeted therapy. Since sorafenib was approved in April 2008, four tyrosine kinase inhibitors and two mammalian target of rapamycin inhibitors have become available in Japan. Most Japanese renal cell carcinoma patients are treated by urologists who are involved in not only kidney surgeries, but also targeted therapy using tyrosine kinase inhibitors, as well as mammalian target of rapamycin inhibitors. Optimal treatment methods are selected from theoretically-based global recommendations, such as the National Comprehensive Cancer Network and European Society for Medical Oncology guidelines; however, real-world clinical practice might be different from that in non-Asian countries. This might be because of different practical conditions; for example, different adverse events and efficacy profiles, different healthcare system, and so on. In the present review, we examine current pharmacotherapy for renal cell carcinoma from evidence-based global data, and compare the reality of Japanese clinical practice to explore the importance of individualized patient therapy.
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Affiliation(s)
- Kazuhiro Yoshimura
- Department of Urology, Kinki University Faculty of Medicine, Osaka-sayama, Osaka, Japan
| | - Hirotsugu Uemura
- Department of Urology, Kinki University Faculty of Medicine, Osaka-sayama, Osaka, Japan
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Miyake H, Miyazaki A, Imai S, Harada KI, Fujisawa M. Early Tumor Shrinkage Under Treatment with First-line Tyrosine Kinase Inhibitors as a Predictor of Overall Survival in Patients with Metastatic Renal Cell Carcinoma: a Retrospective Multi-Institutional Study in Japan. Target Oncol 2015; 11:175-82. [DOI: 10.1007/s11523-015-0385-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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