The impact of deferred cytoreductive nephrectomy to survival in advanced renal cell carcinoma: A systematic review and meta-analysis

Abstract

ObjectivesStage IV renal cell carcinoma (RCC) is associated with significant decrease in survival rates. Cytoreductive nephrectomy (CN) is one of the treatments for stage IV RCC. However, there are studies showing that delayed CN might have benefits to the survival of the patients. We aimed to examine the impact of deferred CN on the survival of patients with advanced RCC in relation to sequential management with targeted therapy (TT). MethodsA literature search was conducted in PubMed, EMBASE, EBSCOhost, MedRxiv, and Scopus. We included randomized clinical trials and non-randomized studies of intervention comparing the overall survival (OS) of upfront CN with deferred CN in patients with advanced RCC undergoing TT. Meta-analysis was carried out using Review Manager v5.4 software. Fixed-effect and random-effects models were used to obtain pooled estimates using hazard ratio and standard error, presented using forest plot with 95% confidence interval (CI). ResultsFour studies were analyzed quantitatively. Our analysis revealed that patients with upfront TT followed by deferred CN had significantly improved OS compared to those who underwent upfront CN followed by deferred TT (hazard hazard 0.5, 95% CI 0.40–0.64, p<0.00001). ConclusionThe findings of the study suggest that considering upfront TT followed by deferred CN may lead to improved OS in patients with advanced RCC. However, more research is needed to fully understand the role, optimal timing, and sequencing of TT and CN in the treatment of advanced RCC.