Patient selection for cytoreductive nephrectomy in combination with targeted therapies or immune checkpoint inhibitors.

Abstract

Recent cytoreductive nephrectomy studies provide continued evidence of the critical role of patient selection prior to surgery. The purpose of this review is to examine current data regarding patient selection for cytoreductive surgery and evaluate, which metastatic renal cell carcinoma (mRCC) patients are likely to benefit from surgical treatment. Individual prognostic factors and risk stratification models can be used to estimate survival for mRCC patients and to aid in patient selection. Recent studies also have demonstrated prognostic value for serum labs or tumor histology.The available data suggests that upfront cytoreductive nephrectomy is associated with benefit for selected mRCC patients with good performance status and favorable or intermediate-risk criteria. Upfront systemic therapy should be considered for patients with poor-risk features and poor surgical candidates after multidisciplinary discussion with surgical and medical oncology teams. Ideal patient selection for cytoreductive nephrectomy should include individual consideration of poor prognostic risk factors and discussion of the potential risks and benefits for surgery.