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One-year OS probability (65% vs 47%, P < 0.01) and proportion of ORR (29.8% vs 3.6%, P < 0.01) were significantly greater for patients treated with VEGFR-TKIs versus those treated with mTORIs.

Conclusion: Targeted therapy has clinical activity following IO treatment. Patients who received VEGFR-TKIs versus mTORIs following IO therapy had improved clinical outcomes. These findings may help inform treatment guidelines and clinical practice for patients post-IO therapy. Patients may continue to experience clinical benefits from targeted therapies after progression on immuno-oncology treatment.

 

The Association of Anxiety and Depression with Perioperative and Oncologic Outcomes Among Patients with Clear Cell Renal Cell Carcinoma Undergoing Nephrectomy. Packiam VT,  Tyson I, Tsivian M, et al. Urol Oncol. 2019 Nov 21. pii: S1078-1439(19)30441-7. doi: 10.1016/j.urolonc.2019.10.017. [Epub ahead of print]

Summary: The authors reviewed the institutional nephrectomy registry of 1,990 adults who underwent radical or partial nephrectomy for unilateral, sporadic, nonmetastatic ccRCC between 1995 and 2011. Baseline anxiety and depression were identified using ICD-9 codes. Associations of anxiety or depression with 30-day complications and oncologic outcomes were evaluated. A total of 197 (10%) patients were identified with a diagnosis of anxiety or depression. Median follow-up among survivors was 10.0 (IQR 7.3-13.6) years, during which time 864 patients died, including 363 from RCC. After PS adjustment, clinical and pathologic features were well balanced between groups. Patients with anxiety or depression had increased overall 30-day complications compared to those without (17% vs. 11%, P = 0.011). No significant differences were noted in time to local ipsilateral recurrence (P = 0.54), distant metastases (P = 0.96), or death from RCC (P = 0.42) between patients with vs. without anxiety or depression, while patients with anxiety or depression trended toward worse overall survival (hazard ratio 1.29, 95%CI 0.98-1.69, P = 0.065).

Conclusion: Neither anxiety nor depression were significantly associated with oncologic outcomes among patients who underwent surgery for localized ccRCC. The trend toward worse overall survival among patients with anxiety or depression warrants further investigation.

 

Understanding Racial Disparities in Renal Cell Carcinoma Incidence: Estimates of Population Attributable Risk in Two US Populations. Callahan CL, Schwartz K, Corley DA, et al. Cancer Causes Control. 2019 Nov 28. doi: 10.1007/s10552-019-01248-1. [Epub ahead of print]

Summary: This study calculated race- and sex-specific population attributable risk percentages (PAR%) and their 95% confidence intervals (CI) for hypertension and chronic kidney disease (CKD) among black and white subjects ≥  50 years of age from the US Kidney Cancer Study (USKC; 965 cases, 953 controls), a case-control study in Chicago and Detroit, and a nested case-control study in the Kaiser Permanente Northern California health care network (KPNC; 2,162 cases, 21,484 controls). The authors also estimated PAR% for other modifiable RCC risk factors (cigarette smoking, obesity) in USKC. In USKC, the PAR% for hypertension was 50% (95% CI 24-77%) and 44% (95% CI 25-64%) among black women and men, respectively, and 29% (95% CI 13-44%) and 27% (95% CI 14-39%) for white women and men, respectively. In KPNC, the hypertension PAR% was 40% (95% CI 18-62%) and 23% (95% CI 2-44%) among black women and men, and 27% (95% CI 20-35%) and 19% (95% CI 14-24%) among white women and men, respectively. The PAR% for CKD in both studies ranged from 7 to 10% for black women and men but was negligible (<1%) for white subjects. In USKC, the PAR% for current smoking was 20% and 8% among black and white men, respectively, and negligible and 8.6% for black and white women, respectively. The obesity PAR% ranged from 12 to 24% across all race/sex strata.

Conclusion: If the associations found are causal, interventions that prevent hypertension and CKD among black Americans could potentially eliminate the racial disparity in RCC incidence (hypothetical black:white RCC incidence ratio of 0.5). KCJ

The Official Journal of the Kidney Cancer Association

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The authors reviewed the institutional nephrectomy registry of 1,990 adults who underwent radical or partial nephrectomy for unilateral, sporadic, nonmetastatic ccRCC between 1995 and 2011.  = 0.011). No significant differences were noted in time to local ipsilateral recurrence ( = 0.54), distant metastases ( = 0.96), or death from RCC ( = 0.42) between patients with vs. without anxiety or depression, while patients with anxiety or depression trended toward worse overall survival (hazard ratio 1.29, 95%CI 0.98-1.69,  = 0.065).

If the associations found are causal, interventions that prevent hypertension and CKD among black Americans could potentially eliminate the racial disparity in RCC incidence (hypothetical black:white RCC incidence ratio of 0.5).

Vol 17, No 3    2019