title: Prognostic significance of cytoreductive nephrectomy in patients with synchronous metastases from renal cell carcinoma treated with first-line sunitinib: a European multiinstitutional study.
abstract: BACKGROUND
  The aim of this study was to evaluate the prognostic role of CN in patients with mRCC and synchronous metastases treated with the VEGF receptor TKI, sunitinib.
  
  
  METHODS
  Patients with a diagnosis of metastases before, at the time of, or within 3 months from the diagnosis of renal cell carcinoma (RCC) and first-line treatment with sunitinib were included. Baseline characteristics were correlated with overall survival (OS) according to hazard ratios estimated from univariate Cox proportional hazards models. Significant factors were then included in a multivariate Cox proportional hazards model.
  
  
  RESULTS
  One hundred eighty-six patients treated between January 2006 and March 2012 were selected. Thirty-six (19%) had not undergone CN. CN was offered to younger patients with better prognoses. Patients who underwent CN lived significantly longer than patients without CN (median OS, 23.9 [95% confidence interval (CI), 20.8-28.8] vs. 9 [95% CI, 4-16.4] months; P < .001). Multivariate analysis showed that CN had an independent prognostic significance. No specific subgroup benefiting from CN was identified.
  
  
  CONCLUSIONS
  CN was an independent favorable prognostic factor in patients with synchronous metastases from RCC, treated with sunitinib. Information regarding the selection of mRCC patients likely to benefit from CN might be derived by ongoing phase III trials.
authors.affiliation: Dept of Clinical Therapeutics, University of Athens, Athens, Greece; Hellenic Genito-Urinary Cancer Group (HGUCG). Electronic address: abamias@med.uoa.gr.
authors.forename: Aristotle
authors.initials: A
authors.lastname: Bamias
authors.affiliation: Dept of Clinical Therapeutics, University of Athens, Athens, Greece; Hellenic Genito-Urinary Cancer Group (HGUCG).
authors.forename: Kimon
authors.initials: K
authors.lastname: Tzannis
authors.affiliation: Hellenic Genito-Urinary Cancer Group (HGUCG); Second Urology Department, University of Athens, Athens, Greece.
authors.forename: Athanasios
authors.initials: A
authors.lastname: Papatsoris
authors.affiliation: Dept of General Medical Oncology and Laboratory for Experimental Oncology, University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Oudard
authors.affiliation: Hôpital Européen Georges Pompidou.
authors.forename: Benoit
authors.initials: B
authors.lastname: Beuselinck
authors.affiliation: Institute Gustav Roussy.
authors.forename: Bernard
authors.initials: B
authors.lastname: Escudier
authors.affiliation: Dept of Clinical Therapeutics, University of Athens, Athens, Greece.
authors.forename: Michalis
authors.initials: M
authors.lastname: Liontos
authors.affiliation: Hôpital Européen Georges Pompidou.
authors.forename: Thierry-Reja
authors.initials: TR
authors.lastname: Elaidi
authors.affiliation: Hellenic Genito-Urinary Cancer Group (HGUCG); Second Urology Department, University of Athens, Athens, Greece.
authors.forename: Michael
authors.initials: M
authors.lastname: Chrisofos
authors.affiliation: Hellenic Genito-Urinary Cancer Group (HGUCG); First Urology Department, University of Athens, Athens, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Stravodimos
authors.affiliation: First Urology Department, University of Athens, Athens, Greece.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Anastasiou
authors.affiliation: Hellenic Genito-Urinary Cancer Group (HGUCG); First Urology Department, University of Athens, Athens, Greece.
authors.forename: Dionisios
authors.initials: D
authors.lastname: Mitropoulos
authors.affiliation: Hellenic Genito-Urinary Cancer Group (HGUCG); Second Urology Department, University of Athens, Athens, Greece.
authors.forename: Charalambos
authors.initials: C
authors.lastname: Deliveliotis
authors.affiliation: Hellenic Genito-Urinary Cancer Group (HGUCG); First Urology Department, University of Athens, Athens, Greece.
authors.forename: Constantinos
authors.initials: C
authors.lastname: Constantinides
authors.affiliation: Dept of Clinical Therapeutics, University of Athens, Athens, Greece; Hellenic Genito-Urinary Cancer Group (HGUCG).
authors.forename: Meletios-Athanasios
authors.initials: MA
authors.lastname: Dimopoulos
authors.affiliation: Hellenic Genito-Urinary Cancer Group (HGUCG); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens, Athens, Greece.
authors.forename: Christina
authors.initials: C
authors.lastname: Bamia
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000556:secondary; D001932:Brain Neoplasms / Q000556:secondary; D002292:Carcinoma, Renal Cell / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D065426:Cytoreduction Surgical Procedures; D018572:Disease-Free Survival; D005060:Europe; D005260:Female; D006801:Humans; D007211:Indoles / Q000627:therapeutic use; D007680:Kidney Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D008297:Male; D009362:Neoplasm Metastasis / Q000188:drug therapy; D009392:Nephrectomy / Q000379:methods*; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use; D011758:Pyrroles / Q000627:therapeutic use; D012189:Retrospective Studies; D000077210:Sunitinib; D016896:Treatment Outcome; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors*
chemical_list: D000970:Antineoplastic Agents; D007211:Indoles; D047428:Protein Kinase Inhibitors; D011758:Pyrroles; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000077210:Sunitinib
keywords: Metastatic; Prognosis; Renal cancer; Surgery; TKI