title: Population-based assessment of survival after cytoreductive nephrectomy versus no surgery in patients with metastatic renal cell carcinoma.
abstract: OBJECTIVE
  To examine the population-based survival rates of patients with metastatic renal cell carcinoma (RCC) treated with cytoreductive nephrectomy (CNT) and compare them with those of patients treated without surgery.
  
  
  METHODS
  Of the 43,143 patients with RCC identified in the 1988-2004 Surveillance, Epidemiology, and End Results database, 5372 had metastatic RCC. Of those, 2447 were treated with CNT (45.5%) and 2925 (54.5%) were not. Univariable and multivariable Cox regression models, as well as matched and unmatched Kaplan-Meier survival analyses, were used. The covariates consisted of age, sex, tumor size, and year of diagnosis.
  
  
  RESULTS
  The 1-, 2-, 5-, and 10-year overall survival rate of the patients treated with CNT was 53.6%, 36.3%, 19.4%, and 12.7% compared with 18.5%, 7.4%, 2.3%, and 1.2% for the no-surgery patients, respectively. The corresponding cancer-specific survival rates were 58.1%, 40.8%, 24.3%, and 18.8% and 24.4%, 11.0%, 4.1%, and 2.9% for the same patient groups. On multivariate analysis, independent predictor status was recorded for treatment type, tumor size, and patient age (all P <.001). Also, relative to CNT, the no-surgery group had a 2.5-fold greater rate of overall and cancer-specific mortality (P <.001). In the matched analyses, virtually the same effect was recorded (hazard ratio 2.6, P <.001).
  
  
  CONCLUSIONS
  The results of our study have shown that CNT significantly improves the survival of patients with metastatic RCC.
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada.
authors.forename: Laurent
authors.initials: L
authors.lastname: Zini
authors.forename: Umberto
authors.initials: U
authors.lastname: Capitanio
authors.forename: Paul
authors.initials: P
authors.lastname: Perrotte
authors.forename: Claudio
authors.initials: C
authors.lastname: Jeldres
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.forename: Philippe
authors.initials: P
authors.lastname: Arjane
authors.forename: Hugues
authors.initials: H
authors.lastname: Widmer
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Patard
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
mesh_terms: D000368:Aged; D002292:Carcinoma, Renal Cell / Q000401:mortality* / Q000556:secondary / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D015996:Survival Rate