title: No role of adjuvant systemic therapy after complete metastasectomy in metastatic renal cell carcinoma?
abstract: OBJECTIVE
  To compare the effects of metastasectomy combined with immunotherapy and metastasectomy alone in the treatment of patients with metastatic renal cell carcinoma.
  
  
  METHODS
  A total of 93 patients who had undergone metastasectomy were included in the study. Patients were categorized according to immunotherapy status, including the immunotherapy group (n = 70) and the no immunotherapy group (n = 23).
  
  
  RESULTS
  In the immunotherapy group, median overall survival was 56.1 months (95% confidence interval [CI] 34.1-78.2), whereas the no immunotherapy group reached a median overall survival of 21.3 months (95% CI 3.4-39.2), respectively. The 1, 3, and 5-year overall survival rates were calculated at 67.1% and 56.5%, 30.0% and 34.8%, and 7.1% and 19.0%, for the immunotherapy group and the no immunotherapy group, respectively (P = 1.000). When patients were stratified according to the time of metastasis, overall survival was not significantly different among the groups in patients with synchronous metastasis or in those with metachronous metastasis. Multivariate Cox proportional hazards model analysis showed that multiplicity of metastasis (odds ratio 3.68; 95% CI 1.85-7.34; P < 0.001) and metastatic sites (odds ratio 2.12; 95% CI 1.15-3.90; P = 0.016) were independent predictors of overall survival.
  
  
  CONCLUSIONS
  Metastasectomy combined with adjuvant immunotherapy did not result in a significantly higher overall survival rate as compared with metastasectomy alone. Our findings raise the question of "Is there a role of adjuvant immunotherapy after complete metastasectomy in patients with metastatic renal cell carcinoma?"
authors.affiliation: Department of Urology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Cheol
authors.initials: C
authors.lastname: Kwak
authors.forename: Yong Hyun
authors.initials: YH
authors.lastname: Park
authors.forename: Chang Wook
authors.initials: CW
authors.lastname: Jeong
authors.forename: Sang Eun
authors.initials: SE
authors.lastname: Lee
authors.forename: Ja Hyeon
authors.initials: JH
authors.lastname: Ku
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007167:Immunotherapy; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D000970:Antineoplastic Agents