Introduction With the advent and availability of targeted therapy, the treatment of advanced/metastatic renal cell carcinoma (RCC) underwent a drastic change in 2005. The impact of this change on clinical outcome, within the population has not been studied. The aim of this study was to evaluate the overall survival (OS), prior to, and post availability of targeted therapy, for advanced RCC cases in the population-based Surveillance, Epidemiology and End Results (SEER) cancer registry. Methods All advanced (regional and distant stage) RCC cases diagnosed within the 2000–2008 time periods were included. Since SEER does not report the exact therapy, and as targeted therapy was initially approved in 2005, we evaluated and compared the OS outcomes of advanced RCC cases diagnosed between the years, 2000–2003 (pre targeted therapy era) with that of those diagnosed between 2005–2008 (targeted therapy era). Results There was a significant improvement in OS for advanced RCC patients treated in the targeted therapy era (N= 12,330) compared to those treated in the pre-targeted therapy era (N=11,565) (Median OS 20 months vs. 15 months, p= 0.0006). Multivariate analysis revealed that the pre-targeted therapy time period, age over 65 years, black race, and lack of nephrectomy were predictors of a shorter OS. Conclusion In univariate and multivariate analysis, targeted therapy demonstrated improvement in OS. Increasing access to targeted therapies is likely to improve outcomes in advanced RCC.

Since LM alone or in combination with TVD are categorised as representing potentially life-threatening variants of CAD, a screening test with high sensitivity, low negative likelihood ratio or higher discriminatory capacity would be desirable for risk stratification. In the absence of a direct head-to-head comparison of the diagnostic accuracies of SE and MPI, our findings indicate that SE appears to be the preferred screening modality for high-risk coronary artery disease.

No abstract