Is nephrectomy no longer beneficial in the management of metastatic kidney cancer?
Notice bibliographique
Résumé
T he headlines are clear: "No patient who presents with metastatic kidney cancer benefits from surgical removal of their primary kidney tumour."This dramatic statement was the conclusion of the CARMENA trial findings presented at the American Society of Clinical Oncology (ASCO) meeting in June 2018, stating that cytoreductive nephrectomy should no longer be part of the standard of care for patients with metastatic renal cell carcinoma (mRCC).This trial randomized patients with mRCC with intermediate-and poor-risk criteria to one of two arms -sunitinib alone or cytoreductive nephrectomy followed by sunitinib.In the final analysis, the median overall survival (OS) was longer in the sunitinib alone arm.As a result of this trial conclusion, which spread quickly throughout the kidney cancer community, the rates of cytoreductive nephrectomy have plummeted across Canada.But are these conclusions absolute?Are there any patients with mRCC who would benefit from surgery on their kidney tumour?In this issue of the CUAJ, Mason et al provide guidance to answer these questions through the The Kidney Cancer Network of Canada (KCRNC) consensus statement on the role of cytoreductive nephrectomy for patients with mRCC.The KCRNC, founded by Dr. Michael Jewett from the University of Toronto, is a network of researchers committed to the facilitation of kidney cancer research in Canada, and includes clinical experts, researchers, and patients.The KCRNC works closely with Kidney Cancer Canada to promote and fund kidney cancer research across Canada, and produces periodic consensus statements to guide clinicians in the management of their kidney cancer patients.The role of cytoreductive nephrectomy has become controversial in the management of mRCC; however, it is clear that selected patients with mRCC would certainly benefit from nephrectomy; this KCRNC consensus provides that guidance.Not all patients should be painted with the same brush that nephrectomy is not indicated.Patients that may benefit from cytoreductive nephrectomy include those patients with good performance status, young age, no systemic symptoms, relatively limited burden of disease, favourable-risk status, and select intermediate-risk patients.Patients with poor-risk status probably would not benefit from cytoreductive nephrectomy.An important caveat in this controversy is that the current systemic management has evolved quickly such that tyrosine kinase inhibitors (TKIs), like sunitinib, are no longer the standard treatment for intermediate-and poor-risk patients; the immuno-oncology (IO) class of therapies is the new standard, either in combination with another IO drug or a TKI.(Stay tuned for an upcoming updated KCRNC consensus on these new therapies.)So is this new CARMENA study already irrelevant?The KCRNC recommends that such patients be discussed in multidisciplinary clinics (urologist, medical oncologist, radiation oncologist, nursing, radiologist, and pathologist) if possible to optimize care for your kidney cancer patient.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,011 | 0,063 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,002 | 0,002 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,003 | 0,004 |
| Communication savante | 0,004 | 0,004 |
| Science ouverte | 0,003 | 0,001 |
| Intégrité de la recherche | 0,010 | 0,016 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,005 | 0,002 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».