title: Cytoreductive nephrectomy in patients with synchronous metastases from renal cell carcinoma: results from the International Metastatic Renal Cell Carcinoma Database Consortium.
abstract: BACKGROUND
  The benefit of cytoreductive nephrectomy (CN) for overall survival (OS) is unclear in patients with synchronous metastatic renal cell carcinoma (mRCC) in the era of targeted therapy.
  
  
  OBJECTIVE
  To determine OS benefit of CN compared with no CN in mRCC patients treated with targeted therapies.
  
  
  METHODS
  Retrospective data from patients with synchronous mRCC (n=1658) from the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) were used to compare 982 mRCC patients who had a CN with 676 mRCC patients who did not.
  
  
  METHODS
  OS was compared and hazard ratios (HRs) adjusted for IMDC poor prognostic criteria.
  
  
  CONCLUSIONS
  Patients who had CN had better IMDC prognostic profiles versus those without (favorable, intermediate, or poor in 9%, 63%, and 28% vs 1%, 45%, and 54%, respectively). The median OS of patients with CN versus without CN was 20.6 versus 9.5 mo (p<0.0001). When adjusted for IMDC criteria to correct for imbalances, the HR of death was 0.60 (95% confidence interval, 0.52-0.69; p<0.0001). Patients estimated to survive <12 mo may receive marginal benefit from CN. Patients who have four or more of the IMDC prognostic criteria did not benefit from CN. Data were collected retrospectively.
  
  
  CONCLUSIONS
  CN is beneficial in synchronous mRCC patients treated with targeted therapy, even after adjusting for prognostic factors. Patients with estimated survival times <12 mo or four or more IMDC prognostic factors may not benefit from CN. This information may aid in patient selection as we await results from randomized controlled trials.
  
  
  RESULTS
  We looked at the survival outcomes of metastatic renal cell carcinoma patients who did or did not have the primary tumor removed. We found that most patients benefited from tumor removal, except for those with four or more IMDC risk factors.
authors.affiliation: Tom Baker Cancer Center, Calgary, Alberta, Canada. Electronic address: daniel.heng@albertahealthservices.ca.
authors.forename: Daniel Y C
authors.initials: DY
authors.lastname: Heng
authors.affiliation: Tom Baker Cancer Center, Calgary, Alberta, Canada.
authors.forename: J Connor
authors.initials: JC
authors.lastname: Wells
authors.affiliation: Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA.
authors.forename: Brian I
authors.initials: BI
authors.lastname: Rini
authors.affiliation: University Hospitals Leuven, Leuven, Belgium.
authors.forename: Benoit
authors.initials: B
authors.lastname: Beuselinck
authors.affiliation: Asan Medical Center, Seoul, South Korea.
authors.forename: Jae-Lyun
authors.initials: JL
authors.lastname: Lee
authors.affiliation: Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Knox
authors.affiliation: Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada.
authors.forename: Georg A
authors.initials: GA
authors.lastname: Bjarnason
authors.affiliation: City of Hope Comprehensive Cancer Cente, Duarte, CA, USA.
authors.forename: Sumanta Kumar
authors.initials: SK
authors.lastname: Pal
authors.affiliation: BCCA Vancouver Cancer Centre, Vancouver, British Columbia, Canada.
authors.forename: Christian K
authors.initials: CK
authors.lastname: Kollmannsberger
authors.affiliation: Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yuasa
authors.affiliation: Stanford Medical Center, Stanford, CA, USA.
authors.forename: Sandy
authors.initials: S
authors.lastname: Srinivas
authors.affiliation: Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Frede
authors.initials: F
authors.lastname: Donskov
authors.affiliation: Department of Clinical Therapeutics, National & Kapodistrian University, Athens, Greece.
authors.forename: Aristotelis
authors.initials: A
authors.lastname: Bamias
authors.affiliation: Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada.
authors.forename: Lori A
authors.initials: LA
authors.lastname: Wood
authors.affiliation: London Regional Cancer Centre, London, Ontario, Canada.
authors.forename: D Scott
authors.initials: DS
authors.lastname: Ernst
authors.affiliation: University of Utah Huntsman Cancer Institute, Salt Lake City, UT, USA.
authors.forename: Neeraj
authors.initials: N
authors.lastname: Agarwal
authors.affiliation: Karmanos Cancer Institute, Detroit, MI, USA.
authors.forename: Ulka N
authors.initials: UN
authors.lastname: Vaishampayan
authors.affiliation: Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Sun Young
authors.initials: SY
authors.lastname: Rha
authors.affiliation: Sidney Kimmel Comprehensive Cancer Center at John Hopkins University, Baltimore, MD, USA.
authors.forename: Jenny J
authors.initials: JJ
authors.lastname: Kim
authors.affiliation: Dana-Farber Cancer Institute, Boston, MA, USA.
authors.forename: Toni K
authors.initials: TK
authors.lastname: Choueiri
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002292:Carcinoma, Renal Cell / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016001:Confidence Intervals; D065426:Cytoreduction Surgical Procedures / Q000379:methods / Q000401:mortality; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007211:Indoles / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D058990:Molecular Targeted Therapy / Q000379:methods; D009378:Neoplasms, Multiple Primary / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D009392:Nephrectomy / Q000379:methods / Q000401:mortality; D016016:Proportional Hazards Models; D011758:Pyrroles / Q000627:therapeutic use; D012189:Retrospective Studies; D018570:Risk Assessment; D000077210:Sunitinib; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D007211:Indoles; D011758:Pyrroles; D000077210:Sunitinib
keywords: Cytoreductive nephrectomy; Metastatic renal cell carcinoma; Targeted therapy