Systematic Review of the Role of Cytoreductive Nephrectomy in the Targeted Therapy Era and Beyond: An Individualized Approach to Metastatic Renal Cell Carcinoma

Bhindi, Bimal; Abel, E. Jason; Albigès, Laurence; Bensalah, Karim; Boorjian, Stephen A.; Daneshmand, Siamak; Karam, Jose A.; Mason, Ross; Powles, Thomas; Bex, Axel

doi:10.1016/j.eururo.2018.09.016

Cited by 145 publications

(71 citation statements)

References 101 publications

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“…Patients with good performance status, minimal symptoms related to metastases, a resectable primary tumor, and a limited burden of metastatic disease might be good candidates for surgery [32]. A systematic review also indicated nephrectomy was bene cial to patients with limited burden of metastasis, well-selected patients based on established prognostic factors, and patients with favorable response for initial systemic therapy [33]. The patients with surgery recommended and performed in this study were more likely to bene t from nephrectomy relative to those without surgery performed, and the subgroup analyses con rmed the robustness of the ndings.…”

Section: Discussionmentioning

confidence: 99%

Development and validation of a nomogram to predict overall survival for patients with metastatic renal cell carcinoma

Zheng

Zhu

et al. 2020

Preprint

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Background: The prognosis of metastatic renal cell carcinoma (RCC) patients vary widely because of clinical and pathological heterogeneity. We aimed to develop a novel nomogram to predict overall survival (OS) for this population. Methods: Metastatic RCC patients were selected from the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2016. These patients were randomly assigned to a training set and a validation set at a ratio of 1:1. Significant prognostic factors of survival were identified through Cox regression models and then integrated to form a nomogram to predict 1-, 3- and 5-year OS. The nomogram was subsequently subjected to validations via the training and the validation sets. The performance of this model was evaluated by using Harrell’s concordance index (C-index), calibration curve, integrated discrimination improvement (IDI), net reclassification improvement (NRI), and decision curve analysis (DCA). Results: Overall, 2315 eligible metastatic RCC patients were enrolled from the SEER database. A nomogram of survival prediction for patients of newly diagnosed with metastatic RCC was established, in which eight clinical factors significantly associated with OS were involved, including Fuhrman grade, lymph node status, sarcomatoid feature, cancer-directed surgery, bone metastasis, brain metastasis, liver metastasis, and lung metastasis. The new model presented better discrimination power than the American Joint Committee on Cancer (AJCC) staging system (7th edition) in the training set (C-indexes, 0.701 vs. 0.612, P <0.001) and the validation set (C-indexes, 0.676 vs. 0.600, P <0.001). The calibration plots of the nomogram exhibited optimal agreement between the predicted values and the observed values. The results of NRI and IDI also indicated the superior predictive capability of the nomogram relative to the AJCC staging system. The DCA plots revealed higher clinical use of our model in survival prediction. Conclusions: We developed and validated an effective nomogram to provide individual OS prediction for metastatic RCC patients, which would be beneficial to clinical trial design, patient counseling, and therapeutic modality selection.

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Section: Discussionmentioning

confidence: 99%

Development and validation of a nomogram to predict overall survival for patients with metastatic renal cell carcinoma

Zheng

Zhu

et al. 2020

Preprint

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“…Researches had shown that patients with mRCC displayed signi cant variability in oncologic outcomes after CN and systemic therapy [11,12]. Bhindi et al reported CN may bring survival bene t to patients with limited metastatic burden, well-selected patients, and patients with favorable response after initial systemic therapy or for symptom's palliation [13]. Larcher et al found that CN could not offer survival bene t for poor or intermediate risk patients who were eligible for systemic therapy [14].…”

Section: Discussionmentioning

confidence: 99%

Metastatic renal cell carcinoma patients of T4 stage who are in status of N1 stage or older than 76 years cannot benefit from Cytoreductive Nephrectomy

Zhang

Yang

et al. 2020

Preprint

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Background: We aimed to identify which part of the patients with metastatic renal cell carcinoma (mRCC) is not suitable for cytoreductive nephrectomy (CN).Methods: The data of mRCC patients was acquired from the Surveillance, Epidemiology, and End Results (SEER) database. Multivariate cox regression analysis and nomogram were performed for selecting factors independently associated with survival. Propensity score matching (PSM) was applied to reduce potential bias when comparing survival of mRCC patients treated by CN or non-surgery (NS). The survival analysis of subgroups was estimated by the Kaplan–Meier method and compared by log-rank testing. The summary of subgroup analysis was showed by forest plots.Results: The records of 21411 patients with mRCC were obtained from the SEER database. After screening, a total of 6532 patients were included for further analysis, of which 6043 underwent CN and 489 underwent NS. Age, T stage, N stage and tumor size were involved in subgroup analysis by PSM according to the result of multivariate cox regression analysis and clinical experience. Survival benefit was not found in T4 stage patients. Further analysis showed that T4&N1 and T4&age≥76yr subgroups could not obtain survival benefit from CN.Conclusion: CN should not be performed in T4 stage mRCC patients who were in status of N1 stage or older than 76 years, because surgery cannot take significant survival benefit for them.

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“…Some recent studies showed that cytoreductive nephrectomy improved antitumor immune system response and overall survival rate for patients with metastatic RCC who underwent the procedure before treatment with interferon alfa 13,14 . However, cytoreductive nephrectomy is controversial for the management of metastatic RCC in the targeted therapy era 15 . Good performance status is a predictor of better overall survival after cytoreductive nephrectomy 16 .…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, complete resection of metastatic disease greatly improves survival 17 19 . Metastasectomy could allow patients to forgo systemic therapy 15 . The present patient's performance status was good, and complete resection of metastatic disease was thus indicated and performed.…”

Section: Discussionmentioning

confidence: 99%

Rare Case of Synchronous Cystic Duct Metastasis from Renal Cell Carcinoma

et al. 2019

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Introduction:The common metastatic sites of renal cell cancer (RCC) are the lung, bone, liver, brain, adrenal glands, and contralateral kidney. Metastasis to the gallbladder is rare, and cystic duct metastasis from RCC has been reported in only one metachronous case. This is the first report of a case of synchronous cystic duct metastasis from RCC. Case Report:A 72-year-old woman presenting with hematuria had a history of Cushing disease approximately 10 years previously. Enhanced computed tomography of the abdomen showed a mass measuring 5.8 × 3.0 cm in the left kidney, which was strongly enhanced in the early phase and washed out in the late phase. A mass measuring 2 cm in diameter was seen in the left adrenal gland, and a 1.0cm mass was noted in the right adrenal gland. Multiple tiny masses were detected in the cystic duct.Left renal cell carcinoma, cystic duct metastasis, and bilateral adrenal gland metastases were diagnosed.Because the metastatic tumor was close to the common bile duct, we performed left nephrectomy, bilateral adrenalectomy, cholecystectomy, resection of the extrahepatic bile duct, and hepaticojejunostomy.Pathological findings showed that the renal tumor was clear cell carcinoma, as were the bilateral adrenal tumors and cystic duct tumor. The patient died 30 months after the operation. (J Nippon Med Sch 2019; 86: 242 247)

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Systematic Review of the Role of Cytoreductive Nephrectomy in the Targeted Therapy Era and Beyond: An Individualized Approach to Metastatic Renal Cell Carcinoma

Cited by 145 publications

References 101 publications

Development and validation of a nomogram to predict overall survival for patients with metastatic renal cell carcinoma

Development and validation of a nomogram to predict overall survival for patients with metastatic renal cell carcinoma

Metastatic renal cell carcinoma patients of T4 stage who are in status of N1 stage or older than 76 years cannot benefit from Cytoreductive Nephrectomy

Rare Case of Synchronous Cystic Duct Metastasis from Renal Cell Carcinoma

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