title: Improved survival in patients with metastatic renal cell carcinoma undergoing cytoreductive nephrectomy in the era of targeted therapy.
abstract: BACKGROUND
  We aimed to review our clinical experience of cytoreductive nephrectomy for patients with metastatic renal cell carcinoma (mRCC) and to identify factors associated with postoperative prognosis in these patients.
  
  
  METHODS
  This study included a total of 164 Japanese patients with mRCC who underwent cytoreductive nephrectomy and subsequently received immunotherapy and/or molecular-targeted therapy between 2000 and 2010.
  
  
  RESULTS
  Baseline characteristics of the 164 patients were as follows: median age was 66 years; metastatic sites included the lung in 133 (81.1 %), bone in 44 (26.8 %), and other in 37 (22.6 %); and 34 (20.7 %), 106 (64.7 %), and 24 (14.6 %) patients were classified into favorable, intermediate-risk, and poor-risk groups, respectively, according to the Memorial Sloan-Kettering Cancer Center (MSKCC) risk model. As postoperative systemic therapy, 80 patients (48.8 %) were treated with immunotherapy alone; the remaining 84 (51.2 %) received molecular-targeted agents irrespective of previous treatment with immunotherapy. Median overall survival of these 164 patients was 25.8 months. Univariate analysis identified the MSKCC risk classification, preoperative C-reactive protein (CRP) level, metastatic site, nodal involvement, presence of sarcomatoid features, histological subtype, and introduction of molecular-targeted agents as significant predictors of overall survival, among which only the preoperative CRP level and introduction of molecular-targeted agents appeared to be independently associated with overall survival.
  
  
  CONCLUSIONS
  Treatment with molecular-targeted agents following cytoreductive nephrectomy may contribute to improve the survival of patients with mRCC compared with immunotherapy alone, and it may be important to employ an aggressive systemic treatment for patients with an increased preoperative value of CRP.
authors.affiliation: Division of Urology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
authors.forename: Iori
authors.initials: I
authors.lastname: Sakai
authors.forename: Hideaki
authors.initials: H
authors.lastname: Miyake
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Hinata
authors.forename: Masato
authors.initials: M
authors.lastname: Fujisawa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000378:metabolism*; D002292:Carcinoma, Renal Cell / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D065426:Cytoreduction Surgical Procedures; D005260:Female; D006801:Humans; D007167:Immunotherapy; D008297:Male; D008875:Middle Aged; D058990:Molecular Targeted Therapy; D009362:Neoplasm Metastasis; D011379:Prognosis; D012307:Risk Factors; D016019:Survival Analysis
chemical_list: D002097:C-Reactive Protein