title: Metastatectomy prior to immunochemotherapy for metastatic renal cell carcinoma.
abstract: BACKGROUND
  We reviewed our experiences in performing cytoreductive metastatectomy before initiating systemic immunochemotherapy and tried to investigate potential prognostic factors for such an approach.
  
  
  METHODS
  A retrospective analysis of 57 patients who received interleukin-2, interferon-alpha, and 5-fluorouracil immunochemotherapy for metastatic renal cell carcinoma was conducted. Before undergoing immunochemotherapy, 20 of the 57 patients had received metastatectomy along with nephrectomy (metastatectomy group) and the other 37 nephrectomy alone (non-metastatectomy group).
  
  
  RESULTS
  The metastatectomy group demonstrated median disease-specific and progression-free survival of 23 and 13 months, respectively. The patients in the metastatectomy group were identified as having a better performance status and primarily demonstrating pulmonary metastasis compared with those in the non-metastatectomy group. As assessed in the metastatectomy group, factors such as the number of metastatic lesions, completeness of metastatectomy, and location of metastatic lesions (lung only vs. others) were observed to be significantly associated with overall survivals on univariate analysis.
  
  
  CONCLUSIONS
  Metastatectomy may still play a significant therapeutic role for metastatic renal cell carcinoma even in the era of immunochemotherapy as part of a multidisciplinary treatment approach in a selected group of patients in adequate general condition who have pulmonary-limited metastasis that can be completely resected.
authors.affiliation: Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Sang Eun
authors.initials: SE
authors.lastname: Lee
authors.forename: Cheol
authors.initials: C
authors.lastname: Kwak
authors.forename: Seok-Soo
authors.initials: SS
authors.lastname: Byun
authors.forename: Myung Chul
authors.initials: MC
authors.lastname: Gill
authors.forename: In Ho
authors.initials: IH
authors.lastname: Chang
authors.forename: Yong June
authors.initials: YJ
authors.lastname: Kim
authors.forename: Sung Kyu
authors.initials: SK
authors.lastname: Hong
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002292:Carcinoma, Renal Cell / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use; D006801:Humans; D016898:Interferon-alpha / Q000627:therapeutic use; D007376:Interleukin-2 / Q000627:therapeutic use; D007680:Kidney Neoplasms / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies
chemical_list: D000970:Antineoplastic Agents; D016898:Interferon-alpha; D007376:Interleukin-2; D005472:Fluorouracil