Cytoreductive Nephrectomy and Overall Survival of Patients with Metastatic Renal Cell Carcinoma Treated with Targeted Therapy—Data from the National Renis Registry

Abstract

The role of cytoreductive nephrectomy (CN) in treatment of locally advanced or metastatic renal cell carcinoma (mRCC) in the era of targeted therapies (TT) is still not clearly defined. The study population consisted of 730 patients with synchronous mRCC. The RenIS (Renal carcinoma Information System) registry was used as the data source. The CN/TT cohort included patients having CN within 3 months from the mRCC diagnosis and subsequently being treated with TT, while the TT cohort included patients receiving TT upfront. Median progression-free survival from the first intervention was 6.7 months in the TT arm and 9.3 months in the CN/TT patients (p < 0.001). Median overall survival was 14.2 and 27.2 months, respectively (p < 0.001). Liver metastasis, high-grade tumor, absence of CN, non-clear cell histology, and MSKCC (Memorial Sloan-Kettering Cancer Center) poor prognosis status were associated with adverse treatment outcomes. According to the results of this retrospective study, patients who underwent CN and subsequently were treated with TT had better outcomes compared to patients treated with upfront TT. The results of the study support the use of CN in the treatment algorithm for mRCC.

Dissecting Outcomes: Should Cytoreductive Nephrectomy Be Performed for Patients With Metastatic Renal Cell Carcinoma With Sarcomatoid Dedifferentiation?

“…The percentage involvement by sarcomatoid differentiation correlates with worse survival outcomes ( 26 ). Although the role of cytoreductive nephrectomy in this particular disease subset has continued to be debated, new evidence from a large cohort at Memorial Sloan Kettering Cancer Center found that, among patients whose tumors have sarcomatoid differentiation, a subset of patients may benefit from cytoreductive nephrectomy if they have clear cell histology, unifocal metastasis not involving the lung or liver, and node-negative disease ( 27 ). It is important to note that this is for all patients with sRCC, not only for those with metastatic cases ( 28 – 30 ).…”

Clinical Review on the Management of Metastatic Renal Cell Carcinoma

“…10 As newer vascular endothelial growth factor (VEGF)directed targeted therapies became available, retrospective data emerged that CN may be of clinical value in patients with mRCC treated with these agents. 11,12 Subsequent prospective trials were thus conducted to investigate the role of CN in patients with mRCC receiving targeted therapy. In the noninferiority CAR-MENA trial, 450 patients with newly diagnosed intermediate-or poor-risk mRCC were randomly assigned to receive sunitinib alone versus a CN followed by sunitinib.…”

The role of cytoreductive nephrectomy in metastatic renal cell carcinoma in the targeted therapy and immunological therapy era: a systematic review and meta-analysis

“…We assessed the risk of bias in 27 cohort studies using the ROBIN-1 tool. The overall risk of bias was determined to be moderate in 21 studies 10 , 18 – 20 , 22 – 35 , 39 – 42 and serious in six studies 17 , 21 , 36 – 38 , 41 . No study was found to be at critical risk of bias (Fig.…”