{"id":"https://openalex.org/W2604119501","doi":"https://doi.org/10.1016/j.juro.2017.02.526","title":"MP16-20 LITMUS TEST OR DESTINATION SYSTEMIC THERAPY? REFERRAL FOR CYTOREDUCTIVE NEPHRECTOMY AFTER INITIAL SYSTEMIC THERAPY IN METASTATIC KIDNEY CANCER","display_name":"MP16-20 LITMUS TEST OR DESTINATION SYSTEMIC THERAPY? REFERRAL FOR CYTOREDUCTIVE NEPHRECTOMY AFTER INITIAL SYSTEMIC THERAPY IN METASTATIC KIDNEY CANCER","publication_year":2017,"publication_date":"2017-04-01","ids":{"openalex":"https://openalex.org/W2604119501","doi":"https://doi.org/10.1016/j.juro.2017.02.526","mag":"2604119501"},"language":"en","primary_location":{"id":"doi:10.1016/j.juro.2017.02.526","doi":"https://doi.org/10.1016/j.juro.2017.02.526","is_oa":false,"landing_page_url":"https://doi.org/10.1016/j.juro.2017.02.526","pdf_url":null,"source":{"id":"https://openalex.org/S30525748","display_name":"The Journal of Urology","issn_l":"0022-5347","issn":["0022-5347","1527-3792"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["anvur-scientific","cwts-core","dongbi-a","doyens","jufo-2","ki-jl-2","medline","norway-2","poland-140","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310315671","host_organization_name":"Lippincott Williams & Wilkins","host_organization_lineage":["https://openalex.org/P4310315671","https://openalex.org/P4310318547"],"host_organization_lineage_names":["Lippincott Williams & Wilkins","Wolters Kluwer"],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Journal of Urology","raw_type":"journal-article"},"volume":null,"type":"article","indexed_in":["crossref"],"open_access":{"is_oa":false,"oa_status":"closed","oa_url":null,"any_repository_has_fulltext":false},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5001062664","display_name":"Liam Connor Macleod","orcid":"https://orcid.org/0000-0003-1163-6621","observed_orcids":["https://orcid.org/0000-0003-1163-6621"]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Liam C. Macleod","raw_affiliation_strings":["Seattle, WA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Seattle, WA","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5104109572","display_name":"Atreya Dash","orcid":"https://orcid.org/0000-0002-2634-5539","observed_orcids":["https://orcid.org/0000-0002-2634-5539"]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Atreya Dash","raw_affiliation_strings":["Seattle, WA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Seattle, WA","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5027535552","display_name":"George R. Schade","orcid":"https://orcid.org/0000-0002-9405-3853","observed_orcids":["https://orcid.org/0000-0002-9405-3853"]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"George R. Schade","raw_affiliation_strings":["Seattle, WA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Seattle, WA","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5070024543","display_name":"Anobel Y. Odisho","orcid":"https://orcid.org/0000-0003-0975-0812","observed_orcids":["https://orcid.org/0000-0003-0975-0812"]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Anobel Y. Odisho","raw_affiliation_strings":["Seattle, WA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Seattle, WA","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5001901126","display_name":"Scott S. Tykodi","orcid":"https://orcid.org/0000-0002-0399-0965","observed_orcids":["https://orcid.org/0000-0002-0399-0965"]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Scott S. Tykodi","raw_affiliation_strings":["Seattle, WA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Seattle, WA","institution_ids":[]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5003319562","display_name":"John L. Gore","orcid":"https://orcid.org/0000-0002-2847-5062","observed_orcids":["https://orcid.org/0000-0002-2847-5062"]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"John L. Gore","raw_affiliation_strings":["Seattle, WA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Seattle, WA","institution_ids":[]}]}],"institutions":[],"countries_distinct_count":0,"institutions_distinct_count":0,"corresponding_author_ids":[],"corresponding_institution_ids":[],"apc_list":{"value":3000,"currency":"USD","value_usd":3000},"apc_paid":null,"fwci":0.0,"has_fulltext":false,"cited_by_count":0,"citation_normalized_percentile":{"value":0.05557061,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":null,"biblio":{"volume":"197","issue":"4S","first_page":null,"last_page":null},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10449","display_name":"Renal cell carcinoma treatment","score":0.9994999766349792,"subfield":{"id":"https://openalex.org/subfields/2740","display_name":"Pulmonary and Respiratory Medicine"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T10449","display_name":"Renal cell carcinoma treatment","score":0.9994999766349792,"subfield":{"id":"https://openalex.org/subfields/2740","display_name":"Pulmonary and Respiratory Medicine"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10458","display_name":"Bladder and Urothelial Cancer Treatments","score":0.0003000000142492354,"subfield":{"id":"https://openalex.org/subfields/2746","display_name":"Surgery"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10522","display_name":"Medical Imaging Techniques and Applications","score":0.0,"subfield":{"id":"https://openalex.org/subfields/2741","display_name":"Radiology, Nuclear Medicine and Imaging"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/metastatic-renal-cell-carcinoma","display_name":"metastatic renal cell carcinoma","score":0.9890000224113464},{"id":"https://openalex.org/keywords/cytoreductive-nephrectomy","display_name":"cytoreductive nephrectomy","score":0.9829999804496765},{"id":"https://openalex.org/keywords/litmus-tests","display_name":"litmus tests","score":0.5770000219345093},{"id":"https://openalex.org/keywords/survival","display_name":"survival","score":0.4300000071525574},{"id":"https://openalex.org/keywords/performance-status","display_name":"performance status","score":0.6740000247955322},{"id":"https://openalex.org/keywords/socioeconomic-status","display_name":"socioeconomic status","score":0.8659999966621399},{"id":"https://openalex.org/keywords/national-cancer-database","display_name":"National Cancer Database","score":0.5789999961853027},{"id":"https://openalex.org/keywords/treatment-sequencing","display_name":"treatment sequencing","score":0.49900001287460327},{"id":"https://openalex.org/keywords/prognostic-factors","display_name":"prognostic factors","score":0.6159999966621399},{"id":"https://openalex.org/keywords/quality-of-life","display_name":"quality of life","score":0.3799999952316284},{"id":"https://openalex.org/keywords/health-care-costs","display_name":"health care costs","score":0.527999997138977},{"id":"https://openalex.org/keywords/health-care-utilization","display_name":"health care utilization","score":0.38999998569488525},{"id":"https://openalex.org/keywords/health-care-access","display_name":"health care access","score":0.3240000009536743},{"id":"https://openalex.org/keywords/health-care-disparities","display_name":"health care disparities","score":0.3019999861717224}],"concepts":[{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.9265254735946655},{"id":"https://openalex.org/C185926286","wikidata":"https://www.wikidata.org/wiki/Q1929812","display_name":"Systemic therapy","level":4,"score":0.7715272903442383},{"id":"https://openalex.org/C2780227381","wikidata":"https://www.wikidata.org/wiki/Q1357376","display_name":"Nephrectomy","level":3,"score":0.5748106241226196},{"id":"https://openalex.org/C121608353","wikidata":"https://www.wikidata.org/wiki/Q12078","display_name":"Cancer","level":2,"score":0.5581771731376648},{"id":"https://openalex.org/C2776907518","wikidata":"https://www.wikidata.org/wiki/Q1734165","display_name":"Performance status","level":3,"score":0.4902994930744171},{"id":"https://openalex.org/C2776135927","wikidata":"https://www.wikidata.org/wiki/Q5242559","display_name":"Referral","level":2,"score":0.4844055771827698},{"id":"https://openalex.org/C2781068499","wikidata":"https://www.wikidata.org/wiki/Q3242950","display_name":"Kidney cancer","level":3,"score":0.4338357746601105},{"id":"https://openalex.org/C126322002","wikidata":"https://www.wikidata.org/wiki/Q11180","display_name":"Internal medicine","level":1,"score":0.39450982213020325},{"id":"https://openalex.org/C141071460","wikidata":"https://www.wikidata.org/wiki/Q40821","display_name":"Surgery","level":1,"score":0.327390193939209},{"id":"https://openalex.org/C2780091579","wikidata":"https://www.wikidata.org/wiki/Q9377","display_name":"Kidney","level":2,"score":0.2652997374534607},{"id":"https://openalex.org/C530470458","wikidata":"https://www.wikidata.org/wiki/Q128581","display_name":"Breast cancer","level":3,"score":0.18678578734397888},{"id":"https://openalex.org/C512399662","wikidata":"https://www.wikidata.org/wiki/Q3505712","display_name":"Family medicine","level":1,"score":0.18301981687545776}],"mesh":[],"locations_count":1,"locations":[{"id":"doi:10.1016/j.juro.2017.02.526","doi":"https://doi.org/10.1016/j.juro.2017.02.526","is_oa":false,"landing_page_url":"https://doi.org/10.1016/j.juro.2017.02.526","pdf_url":null,"source":{"id":"https://openalex.org/S30525748","display_name":"The Journal of Urology","issn_l":"0022-5347","issn":["0022-5347","1527-3792"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["anvur-scientific","cwts-core","dongbi-a","doyens","jufo-2","ki-jl-2","medline","norway-2","poland-140","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310315671","host_organization_name":"Lippincott Williams & Wilkins","host_organization_lineage":["https://openalex.org/P4310315671","https://openalex.org/P4310318547"],"host_organization_lineage_names":["Lippincott Williams & Wilkins","Wolters Kluwer"],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Journal of Urology","raw_type":"journal-article"}],"best_oa_location":null,"sustainable_development_goals":[{"score":0.9922999739646912,"display_name":"Good health and well-being","id":"https://metadata.un.org/sdg/3"}],"sustainable_development_goals_aurora":[],"study_designs":[{"display_name":"Observational Study","id":"https://openalex.org/study-designs/observational-study"}],"awards":[],"funders":[],"has_content":{"grobid_xml":false,"pdf":false},"content_urls":null,"referenced_works_count":0,"referenced_works":[],"related_works":["https://openalex.org/W2602763112","https://openalex.org/W2320647165","https://openalex.org/W4224107712","https://openalex.org/W2605252358","https://openalex.org/W4360605668","https://openalex.org/W3189975707","https://openalex.org/W2768526209","https://openalex.org/W1726825681","https://openalex.org/W4214495107","https://openalex.org/W2054898553"],"abstract_inverted_index":{"You":[0],"have":[1],"accessJournal":[2],"of":[3,190,197,208,307,316,331,361,374,399],"UrologyKidney":[4],"Cancer:":[5],"Advanced":[6],"(including":[7],"Drug":[8],"Therapy)":[9],"II1":[10],"Apr":[11],"2017MP16-20":[12],"LITMUS":[13],"TEST":[14],"OR":[15],"DESTINATION":[16],"SYSTEMIC":[17,25],"THERAPY?":[18],"REFERRAL":[19],"FOR":[20],"CYTOREDUCTIVE":[21],"NEPHRECTOMY":[22],"AFTER":[23],"INITIAL":[24],"THERAPY":[26],"IN":[27],"METASTATIC":[28],"KIDNEY":[29],"CANCER":[30],"Liam":[31,49,431],"C.":[32,50,52,432],"Macleod,":[33],"Atreya":[34,60,439],"Dash,":[35],"George":[36,69,446],"R.":[37,70,72,447],"Schade,":[38],"Anobel":[39,80,454],"Y.":[40,81,83,455],"Odisho,":[41],"Scott":[42,91,462],"S.":[43,92,94,463],"Tykodi,":[44],"and":[45,102,148,215,243,247,342,344,366],"John":[46,103,470],"L.":[47,104,106,471],"Gore":[48,107,472],"MacleodLiam":[51],"Macleod":[53,433],"More":[54,63,74,85,96,108,434,441,449,457,465,473],"articles":[55,64,75,86,97,109,435,442,450,458,466,474],"by":[56,65,76,87,98,110,436,443,451,459,467,475],"this":[57,66,77,88,99,111,437,444,452,460,468,476],"author":[58,67,78,89,100,112,438,445,453,461,469,477],",":[59,68,79,90,101],"DashAtreya":[61],"Dash":[62,440],"SchadeGeorge":[71],"Schade":[73,448],"OdishoAnobel":[82],"Odisho":[84,456],"TykodiScott":[93],"Tykodi":[95,464],"GoreJohn":[105],"View":[113],"All":[114,479],"Author":[115],"Informationhttps://doi.org/10.1016/j.juro.2017.02.526AboutPDF":[116],"ToolsAdd":[117],"to":[118,185,200,403],"favoritesDownload":[119],"CitationsTrack":[120],"CitationsPermissionsReprints":[121],"ShareFacebookTwitterLinked":[122],"InEmail":[123],"INTRODUCTION":[124],"AND":[125],"OBJECTIVES":[126],"With":[127],"numerous":[128],"new":[129],"agents":[130],"for":[131,225,269,387],"metastatic":[132,346],"kidney":[133],"cancer":[134],"(mRCC)":[135],"since":[136],"2005,":[137],"there":[138],"is":[139,381,385],"no":[140],"randomized":[141],"data":[142],"supporting":[143],"sequencing":[144],"cytoreductive":[145],"nephrectomy":[146],"(CN)":[147],"newer":[149],"systemic":[150,234],"therapies":[151],"(ST).":[152],"Increased":[153],"disease":[154,214],"control":[155],"with":[156,203,228,232,256,266,283,293,305,328,352,359,389],"ST":[157,176,268,294,384],"engenders":[158],"concern":[159],"that":[160,414],"CN":[161,191,199,257,281,308,332,375,409],"may":[162,181,407],"shorten":[163],"life":[164],"or":[165],"delay":[166],"therapy.":[167],"Thus,":[168],"in":[169,376],"all":[170,353],"the":[171,377],"best":[172],"prognostic":[173],"candidates,":[174],"initial":[175,193,233,259,267,395],"as":[177],"a":[178,411],"\u2033litmus\u2033":[179],"test":[180],"be":[182,201],"advocated":[183],"prior":[184],"CN.":[186,325,404],"We":[187],"evaluated":[188],"use":[189],"after":[192,258,393],"ST,":[194],"hypothesizing":[195],"receipt":[196,306,360],"deferred":[198],"associated":[202,255,304,327,358],"increased":[204,209],"survival":[205,299],"time,":[206],"markers":[207],"performance":[210],"status,":[211],"less":[212],"rapid":[213],"socioeconomic":[216],"status.":[217],"METHODS":[218],"The":[219],"National":[220],"Cancer":[221],"Database":[222],"was":[223,251,302,357],"screened":[224],"adult":[226],"patients":[227,264],"biopsy-proven":[229],"mRCC":[230,379],"treated":[231,265,292],"therapy":[235],"between":[236],"2006-2013.":[237],"Covariates":[238],"included":[239,333],"demographic,":[240],"oncologic,":[241],"hospital-level":[242],"geographic":[244],"variables.":[245],"Unadjusted":[246],"multivariable":[248,297],"logistic":[249],"regression":[250],"performed,":[252],"identifying":[253],"factors":[254,406],"ST.":[260],"RESULTS":[261],"Of":[262],"14,651":[263],"mRCC,":[270],"709":[271],"(4.8%,":[272],"median":[273,286],"OS":[274,287],"19":[275],"months,":[276,289,320],"IQR":[277,290],"9-35)":[278],"underwent":[279,324],"delayed":[280],"compared":[282],"13,942":[284],"(95.2%,":[285],"5":[288],"2-13)":[291],"alone.":[295],"On":[296],"analysis,":[298],"\u22653":[300,319],"months":[301],"highly":[303],"(OR":[309],"10.6,":[310],"95%":[311],"CI":[312],"5.5,":[313],"20.5).":[314],"However,":[315],"9,796":[317],"surviving":[318],"only":[321],"689":[322],"(7%)":[323],"Factors":[326],"lower":[329],"odds":[330],"older":[334],"age,":[335],"greater":[336],"comorbidity,":[337],"higher":[338],"clinical":[339],"stage":[340],"(T":[341],"N),":[343],"unfavorable":[345],"sites":[347],"(i.e.,":[348],"brain,":[349],"bone,":[350],"liver)":[351],"p<0.001.":[354],"Educational":[355],"attainment":[356],"CN,":[362],"but":[363],"hospital":[364],"characteristics":[365],"travel":[367],"burden":[368],"were":[369],"not.":[370],"CONCLUSIONS":[371],"Conclusions:":[372],"Effectiveness":[373],"modern":[378],"era":[380],"uncertain.":[382],"Initial":[383],"typically":[386],"those":[388],"poor":[390],"prognosis.":[391],"Yet,":[392],"an":[394],"litmus":[396],"test,":[397],"re-evaluation":[398],"risk":[400],"rarely":[401],"leads":[402],"Socioeconomic":[405],"affect":[408],"decision-making,":[410],"potential":[412],"disparity":[413],"merits":[415],"further":[416],"investigation.":[417],"\u00a9":[418],"2017FiguresReferencesRelatedDetails":[419],"Volume":[420],"197Issue":[421],"4SApril":[422],"2017Page:":[423],"e187-e188":[424],"Advertisement":[425,480,481],"Copyright":[426],"&":[427],"Permissions\u00a9":[428],"2017MetricsAuthor":[429],"Information":[430],"Expand":[478],"PDF":[482],"downloadLoading":[483],"...":[484]},"counts_by_year":[],"updated_date":"2026-10-02T10:15:12.560889","created_date":"2017-04-14T00:00:00"}