Abstract
BackgroundThe purpose of this study was to evaluate the effects of cytoreductive nephrectomy (CN) and metastasectomies on the survival of patients with synchronous metastatic renal cell cancer (mRCC) using real-life, population-based national dataset.MethodsNationwide data, including all cases of synchronous mRCC in Finland diagnosed on a 6-year timeframe, based on the Finnish Cancer Registry and complemented with patient records from the treating hospitals, were analyzed. Patients with Eastern Cooperative Oncology Group (ECOG) performance status 3–4 were excluded. Univariate and adjusted multivariable survival analysis were performed, including subgroup analysis for patients with different medical therapies. Nephrectomy complications were also analyzed.ResultsA total of 732 patients were included in the analysis. CN was performed for 389 (53.1%) patients, whereas 68 (9.3%) patients underwent nephrectomy and metastasectomies of all lesions (surgery with curative intent). Median overall survival (OS) for patients who did not undergo nephrectomy was 5.9 (95% confidence interval [CI] = 4.6–7.2) months. Patients who had a CN had a median OS of 16.6 (95% CI = 14.2–19.1, p < 0.001) months, whereas patients who had surgery with curative intent had a median OS of 51.3 (95% CI = 36.0–66.6, p < 0.001) months. The survival benefit of CN and metastasectomies remained significant in all medical therapy subgroups and in both of the applied multivariable statistical models.ConclusionsSurgical treatment of metastatic renal cell cancer is associated with a significant survival benefit in patients with good and moderate performance status, regardless of the chosen medical therapy.
Highlights
The survival benefit of cytoreductive nephrectomy (CN) in metastatic renal cell cancer (mRCC) is well established in the era of cytokine-based medical therapy [1, 2]
The survival benefit of CN in mRCC is well established in the era of cytokine-based medical therapy [1, 2]
Contemporary targeted therapy (TT) with tyrosine kinase inhibitor (TKI) and mammalian target of rapamycin inhibitor medications have shown superior results compared to interferon therapy [3,4,5]
Summary
The survival benefit of CN in mRCC is well established in the era of cytokine-based medical therapy [1, 2]. Multiple retrospective studies continue to support CN as a part of the multimodality treatment regimen in metastatic renal cell cancer in the TT era [7,8,9]. Nephrectomy-induced azotaemia and mild metabolic acidosis have been suggested as a possible biological explanation for survival benefit in these patients [14]. The purpose of this study was to evaluate the effects of cytoreductive nephrectomy (CN) and metastasectomies on the survival of patients with synchronous metastatic renal cell cancer (mRCC) using real-life, population-based national dataset
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