Cancer - Kidney(구연) (E-079)

건강보험 빅데이터 전이신장암 환자에서 세포감퇴 신적출술의 역할
중앙대학교병원, 비뇨의학교실
국준희, 심재헌, 지병훈, 김진욱, 장인호, 김태형, 명순철, 최세영
Objectives: To compare the survival outcomes between patients with metastatic renal cell carcinoma (RCC) treated with cytoreductive nephrectomy (CN) and without CN.
Materials and methods: We evaluated the National Health Insurance Service Database diagnosed with RCC between 2004 and 2016. We excluded other cancer before RCC diagnosis with minimum wash-out period of 2 years and no systemic therapy experience. The patients had treated with systemic therapy for metastatic RCC with or without cytoreductive nephrectomy (CN group and non-CN group). To reduce selection bias, propensity score matching (PSM) was conducted by age, sex and Charlson comorbidity index (CCI). Overall survival (OS) was compared between two groups by Kaplan-Meier method and Cox regression model in total cohort and PSM cohort.
Results: Among 8,962 patients with metastatic RCC, 2,695 patients underwent cytoreductive nephrectomy with systemic therapy and 6,267 patients received only systemic therapy. Non-CN group had older age (p<0.0001), more male gender (p=0.03), and higher CCI (p<0.0001), but after PSM the variables were well-matched (D<0.1). In total cohort, cytoreductive nephrectomy was a significant factor for OS (hazard ratio [HR] 0.621, 95% confidence interval [CI] 0.589-0.656, p<0.0001). In PSM cohort, cytoreductive nephrectomy was also a significant factor for OS (HR 0.807, 95% CI 0.742-0.878, p<0.0001).
Conclusion: CN was performed in about 30% of metastatic RCC with systemic therapy. In appropriate surgical candidates, CN may offer a benefit for OS.
keywords : cytoreductive nephrectomy, systemic therapy, mortality

프린트