Performance status and cytoreductive nephrectomy redefining management in patients with poor performance

Brian Shuch, Jeff C La Rochelle, Jon Wu, Tobias Klatte, Stephen B. Riggs, Fairooz Kabbinavar, Arie S. Belldegrun, Allan J. Pantuck

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

BACKGROUND. An Eastern Cooperative Oncology Group performance status (ECOG PS) of 2/3 can quantify cancer patients' well being and may be used to select patients for treatment. The objective of the current study was to investigate the outcomes of cytoreductive nephrectomy (CN) for patients who have an impaired performance status (ECOG PS 2/3). METHODS. Patients who underwent CN for renal cell carcinoma (RCC) between 1989 and 2006 were identified. Patient records were reviewed for age, symptoms, ECOG PS, tumor size, stage, grade, histology, sarcomatoid features, lymph node metastasis, site of metastasis, and the presence of bone metastases (BM) in weightbearing structures. The relation of ECOG PS to outcome variables was evaluated. RESULTS. Four hundred eighteen patients underwent CN, including 117 patients who had an ECOG PS of 0, 274 patients who had an ECOG PS of 1, and 27 patients who had an ECOG PS of 2/3. Patients who had a worse ECOG PS were younger, had higher tumor classification and grade, and more frequently demonstrated anemia and BM. Only 37.5% of patients who had an ECOG PS of 2/3 experienced an improvement in performance in the postoperative period, and only 57.5% went on to receive systemic therapy, of whom none attained an objective responses. The median disease-specific survival for patients who had an ECOG PS of 0, 1, and 2/3 was 27 months, 13.8 months, and 6.6 months, respectively (P <.001). Patients who had an ECOG PS of 2/3 could be stratified further by the presence or absence of BM into 2 groups (median disease-specific survival: 17.7 months and 2.1 months, respectively; P = .006). CONCLUSIONS. Surgery in patients who have a poor performance may serve a palliative function but should be performed with caution because of the poor outcome of such patients. ECOG PS is influenced strongly by BM. A subset of patients with an ECOG PS of 2/3 that are symptomatic specifically from BM may derive greater benefit from CN than patients who hare symptomatic because of visceral metastases. Cancer Society.

Original languageEnglish (US)
Pages (from-to)1324-1331
Number of pages8
JournalCancer
Volume113
Issue number6
DOIs
StatePublished - Sep 15 2008
Externally publishedYes

Fingerprint

Nephrectomy
Neoplasm Metastasis
Bone and Bones
Neoplasms
Hares
Survival
Weight-Bearing
Renal Cell Carcinoma
Postoperative Period
Anemia

Keywords

  • Bone metastases
  • Cytoreductive nephrectomy
  • Eastern Cooperative Oncology Group
  • Performance status
  • Renal cell carcinoma

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Shuch, B., Rochelle, J. C. L., Wu, J., Klatte, T., Riggs, S. B., Kabbinavar, F., ... Pantuck, A. J. (2008). Performance status and cytoreductive nephrectomy redefining management in patients with poor performance. Cancer, 113(6), 1324-1331. https://doi.org/10.1002/cncr.23708

Performance status and cytoreductive nephrectomy redefining management in patients with poor performance. / Shuch, Brian; Rochelle, Jeff C La; Wu, Jon; Klatte, Tobias; Riggs, Stephen B.; Kabbinavar, Fairooz; Belldegrun, Arie S.; Pantuck, Allan J.

In: Cancer, Vol. 113, No. 6, 15.09.2008, p. 1324-1331.

Research output: Contribution to journalArticle

Shuch, B, Rochelle, JCL, Wu, J, Klatte, T, Riggs, SB, Kabbinavar, F, Belldegrun, AS & Pantuck, AJ 2008, 'Performance status and cytoreductive nephrectomy redefining management in patients with poor performance', Cancer, vol. 113, no. 6, pp. 1324-1331. https://doi.org/10.1002/cncr.23708
Shuch B, Rochelle JCL, Wu J, Klatte T, Riggs SB, Kabbinavar F et al. Performance status and cytoreductive nephrectomy redefining management in patients with poor performance. Cancer. 2008 Sep 15;113(6):1324-1331. https://doi.org/10.1002/cncr.23708
Shuch, Brian ; Rochelle, Jeff C La ; Wu, Jon ; Klatte, Tobias ; Riggs, Stephen B. ; Kabbinavar, Fairooz ; Belldegrun, Arie S. ; Pantuck, Allan J. / Performance status and cytoreductive nephrectomy redefining management in patients with poor performance. In: Cancer. 2008 ; Vol. 113, No. 6. pp. 1324-1331.
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abstract = "BACKGROUND. An Eastern Cooperative Oncology Group performance status (ECOG PS) of 2/3 can quantify cancer patients' well being and may be used to select patients for treatment. The objective of the current study was to investigate the outcomes of cytoreductive nephrectomy (CN) for patients who have an impaired performance status (ECOG PS 2/3). METHODS. Patients who underwent CN for renal cell carcinoma (RCC) between 1989 and 2006 were identified. Patient records were reviewed for age, symptoms, ECOG PS, tumor size, stage, grade, histology, sarcomatoid features, lymph node metastasis, site of metastasis, and the presence of bone metastases (BM) in weightbearing structures. The relation of ECOG PS to outcome variables was evaluated. RESULTS. Four hundred eighteen patients underwent CN, including 117 patients who had an ECOG PS of 0, 274 patients who had an ECOG PS of 1, and 27 patients who had an ECOG PS of 2/3. Patients who had a worse ECOG PS were younger, had higher tumor classification and grade, and more frequently demonstrated anemia and BM. Only 37.5{\%} of patients who had an ECOG PS of 2/3 experienced an improvement in performance in the postoperative period, and only 57.5{\%} went on to receive systemic therapy, of whom none attained an objective responses. The median disease-specific survival for patients who had an ECOG PS of 0, 1, and 2/3 was 27 months, 13.8 months, and 6.6 months, respectively (P <.001). Patients who had an ECOG PS of 2/3 could be stratified further by the presence or absence of BM into 2 groups (median disease-specific survival: 17.7 months and 2.1 months, respectively; P = .006). CONCLUSIONS. Surgery in patients who have a poor performance may serve a palliative function but should be performed with caution because of the poor outcome of such patients. ECOG PS is influenced strongly by BM. A subset of patients with an ECOG PS of 2/3 that are symptomatic specifically from BM may derive greater benefit from CN than patients who hare symptomatic because of visceral metastases. Cancer Society.",
keywords = "Bone metastases, Cytoreductive nephrectomy, Eastern Cooperative Oncology Group, Performance status, Renal cell carcinoma",
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AU - Rochelle, Jeff C La

AU - Wu, Jon

AU - Klatte, Tobias

AU - Riggs, Stephen B.

AU - Kabbinavar, Fairooz

AU - Belldegrun, Arie S.

AU - Pantuck, Allan J.

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N2 - BACKGROUND. An Eastern Cooperative Oncology Group performance status (ECOG PS) of 2/3 can quantify cancer patients' well being and may be used to select patients for treatment. The objective of the current study was to investigate the outcomes of cytoreductive nephrectomy (CN) for patients who have an impaired performance status (ECOG PS 2/3). METHODS. Patients who underwent CN for renal cell carcinoma (RCC) between 1989 and 2006 were identified. Patient records were reviewed for age, symptoms, ECOG PS, tumor size, stage, grade, histology, sarcomatoid features, lymph node metastasis, site of metastasis, and the presence of bone metastases (BM) in weightbearing structures. The relation of ECOG PS to outcome variables was evaluated. RESULTS. Four hundred eighteen patients underwent CN, including 117 patients who had an ECOG PS of 0, 274 patients who had an ECOG PS of 1, and 27 patients who had an ECOG PS of 2/3. Patients who had a worse ECOG PS were younger, had higher tumor classification and grade, and more frequently demonstrated anemia and BM. Only 37.5% of patients who had an ECOG PS of 2/3 experienced an improvement in performance in the postoperative period, and only 57.5% went on to receive systemic therapy, of whom none attained an objective responses. The median disease-specific survival for patients who had an ECOG PS of 0, 1, and 2/3 was 27 months, 13.8 months, and 6.6 months, respectively (P <.001). Patients who had an ECOG PS of 2/3 could be stratified further by the presence or absence of BM into 2 groups (median disease-specific survival: 17.7 months and 2.1 months, respectively; P = .006). CONCLUSIONS. Surgery in patients who have a poor performance may serve a palliative function but should be performed with caution because of the poor outcome of such patients. ECOG PS is influenced strongly by BM. A subset of patients with an ECOG PS of 2/3 that are symptomatic specifically from BM may derive greater benefit from CN than patients who hare symptomatic because of visceral metastases. Cancer Society.

AB - BACKGROUND. An Eastern Cooperative Oncology Group performance status (ECOG PS) of 2/3 can quantify cancer patients' well being and may be used to select patients for treatment. The objective of the current study was to investigate the outcomes of cytoreductive nephrectomy (CN) for patients who have an impaired performance status (ECOG PS 2/3). METHODS. Patients who underwent CN for renal cell carcinoma (RCC) between 1989 and 2006 were identified. Patient records were reviewed for age, symptoms, ECOG PS, tumor size, stage, grade, histology, sarcomatoid features, lymph node metastasis, site of metastasis, and the presence of bone metastases (BM) in weightbearing structures. The relation of ECOG PS to outcome variables was evaluated. RESULTS. Four hundred eighteen patients underwent CN, including 117 patients who had an ECOG PS of 0, 274 patients who had an ECOG PS of 1, and 27 patients who had an ECOG PS of 2/3. Patients who had a worse ECOG PS were younger, had higher tumor classification and grade, and more frequently demonstrated anemia and BM. Only 37.5% of patients who had an ECOG PS of 2/3 experienced an improvement in performance in the postoperative period, and only 57.5% went on to receive systemic therapy, of whom none attained an objective responses. The median disease-specific survival for patients who had an ECOG PS of 0, 1, and 2/3 was 27 months, 13.8 months, and 6.6 months, respectively (P <.001). Patients who had an ECOG PS of 2/3 could be stratified further by the presence or absence of BM into 2 groups (median disease-specific survival: 17.7 months and 2.1 months, respectively; P = .006). CONCLUSIONS. Surgery in patients who have a poor performance may serve a palliative function but should be performed with caution because of the poor outcome of such patients. ECOG PS is influenced strongly by BM. A subset of patients with an ECOG PS of 2/3 that are symptomatic specifically from BM may derive greater benefit from CN than patients who hare symptomatic because of visceral metastases. Cancer Society.

KW - Bone metastases

KW - Cytoreductive nephrectomy

KW - Eastern Cooperative Oncology Group

KW - Performance status

KW - Renal cell carcinoma

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