title: Cytokine therapy response as a selection criterion for cytoreductive nephrectomy in metastatic renal clear-cell carcinoma of intermediate prognosis. Results and conclusions from a combined analysis.
abstract: OBJECTIVE
  To assess the strategy of using an absence of progression at metastatic sites following initial cytokine therapy outcome as a selection criterion for nephrectomy in patients with synchronous metastatic renal carcinoma and an intermediate prognosis according to the Memorial Sloan Kettering prognostic index classification.
  
  
  METHODS
  A combined retrospective analysis of patients with clear-cell subtype from studies of initial cytokine treatment response to assist with selection of patients for nephrectomy. We analyzed survival times, UCLA integrated staging system scores, number of nephrectomies and risk of progression to unresectability of the primary tumor during treatment.
  
  
  RESULTS
  There were 33 patients in total. Nephrectomies were not performed in 10 (30%) patients whose cancers had progressed at metastatic sites. Median survival time was 4 months with none of the patients dying of local tumor progression. The median survival time of the 21 patients with nonprogressive cancer and the primary removed was 17 months. Of those, 8 had a survival time < or =1 year (median 8.5 months) and a progression-free survival time of 4 months and 13 had a survival time >1 year (median 25 months). The median progression-free survival time was 7 months (4-57 months). Four of the 5 objective responses at metastatic sites (5/33, 14%) occurred in those surviving >1 year.
  
  
  CONCLUSIONS
  We propose that progression at metastatic sites during initial immunotherapy may be used to identify patients with a short survival time and who are unlikely to benefit from nephrectomy.
authors.affiliation: Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands. a.bex@nki.nl
authors.forename: Axel
authors.initials: A
authors.lastname: Bex
authors.forename: John B A G
authors.initials: JB
authors.lastname: Haanen
authors.forename: Florry A
authors.initials: FA
authors.lastname: Vyth-Dreese
authors.forename: Simon
authors.initials: S
authors.lastname: Horenblas
authors.forename: Gijsbert C
authors.initials: GC
authors.lastname: de Gast
mesh_terms: D000328:Adult; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000188:drug therapy* / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D003131:Combined Modality Therapy; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D007279:Injections, Subcutaneous; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000627:therapeutic use*; D007680:Kidney Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods; D018579:Patient Selection; D011336:Probability; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D011994:Recombinant Proteins; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins