Deriving International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) Risk Categories Using Oncology Electronic Health Records (EHRS)
Author(s)
Mathur R1, Barata PC2, Tan WK1, Pini TM1, Magee K1, Baxi S1
1Flatiron Health, New York, NY, USA, 2Tulane University, New Orleans, LA, USA
OBJECTIVES: As IMDC risk score is not documented in routine clinical care, we derived IMDC risk categories based on available data for patients with advanced renal cell carcinoma (aRCC) receiving standard first-line (1L) therapy selected from an oncology EHR and measured its characteristics. METHODS: This study used the nationwide Flatiron Health EHR-derived de-identified database. We included 1,416 patients treated with 1L TKI monotherapy and 436 patients treated with 1L ipilimumab, nivolumab combination therapy (IO cohort) on or after Jan 1, 2016. IMDC risk categories were derived by counting negative prognostic factors to create mutually exclusive groups: favorable (0), intermediate (1-2), poor (3+), poor/intermediate (1-2; incomplete information in remaining factors), and unknown (0; incomplete information in remaining factors). Availability of each IMDC prognostic factor and IMDC risk categories were summarized by cohort. Cox proportional hazards models estimated the association between derived IMDC risk categories and real-world overall survival (rwOS). RESULTS: Availability of IMDC prognostic factors in the TKI / IO cohorts, respectively (%): time from initial diagnosis, 99.9 /100.0; Karnofsky performance score, 61.3 / 66.3; absolute neutrophil count, 52.2 / 69.5; hemoglobin levels, 71.3 / 90.1; platelet levels, 60.0 / 80.5; calcium levels, 61.3 / 83.3. Distribution of IMDC risk categories in the TKI / IO cohorts, respectively (%): Poor, 15.5 / 21.6; Poor/Intermediate, 36.4 / 27.3; Intermediate, 22.5 / 32.8; Favorable, 4.4 / 6.0; Unknown, 21.2 / 12.4. When comparing favorable to non-favorable (ref; poor, poor/intermediate, and intermediate), the hazard ratio for rwOS in the TKI / IO cohorts: 0.31 (95% CI: 0.20, 0.50) / 0.27 (95% CI: 0.08, 0.84). CONCLUSIONS: Derived IMDC risk categories can provide valuable prognostic information to enhance the utility of EHR data in aRCC research.
Conference/Value in Health Info
2020-11, ISPOR Europe 2020, Milan, Italy
Value in Health, Volume 23, Issue S2 (December 2020)
Code
PCN339
Topic
Clinical Outcomes, Methodological & Statistical Research
Topic Subcategory
Clinical Outcomes Assessment, Missing Data
Disease
Oncology