SAN FRANCISCO, CA USA (UroToday.com) - Unfortunately, in targeted therapy era, the role of cytoreductive nephrectomy (CN) still remains unclear in patients with synchronous metastases from renal cell carcinoma (mRCC).
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The authors performed a comparison study between patients who received cytoreductive nephrectomy (at different institutions throughout North America, Europe, and Asia) versus those who did not. Out of 3 245 patients, 2 569, or 79% of mRCC patients, received cytoreductive nephrectomy. One-thousand six-hundred and thirty-four patients who had nephrectomy before the diagnosis of metastatic disease were excluded from the analysis. Nine-hundred thirty-five patients received cytoreductive nephrectomy and 676 patients did not have nephrectomy. All patients received targeted therapy, with the majority (72%) receiving first-line sunitinib, sorafenib 15%, temsirolimus 5%, bevacizumab 3%, and pazopanib 3%. The median overall survival of patients who received cytoreductive nephrectomy vs those who did not, was 20.6 vs 9.5 months (p < 0.0001). Dr. Chin-Heng showed that those patients who were estimated to survive less than 9-12 months had only a marginal benefit compared to those with longer estimated survival.
Overall the conclusion of this study is that cytoreductive surgery in the targeted therapy era should be offered to those patients who have good performance status, as this can improve their overall survival. Benefits of surgery in these patients have been shown in prior institutional studies, and only results from randomized controlled clinical trials will shine more light on this matter.
Highlights of a presentation by Daniel Yick Chin Heng, MD at the 2014 Genitourinary Cancers Symposium - January 30 - February 1, 2014 - San Francisco Marriott Marquis - San Francisco, California USA
The Cleveland Clinic, Cleveland, OH USA