title: Nephrectomy improves overall survival in patients with metastatic renal cell carcinoma in cases of favorable MSKCC or ECOG prognostic features.
abstract: OBJECTIVE
  The role of cytoreductive nephrectomy (CN) in the treatment of patients harboring metastatic renal cell carcinoma (mRCC) has become controversial since the emergence of effective targeted therapies. The aim of our study was to compare the overall survival (OS) between CN and non-CN groups of patients presenting with mRCC in the era of targeted drugs and to assess these outcomes among the different Memorial Sloan-Kettering Cancer Center (MSKCC) and The Eastern Cooperative Oncology Group (ECOG) performance status subgroups.
  
  
  METHODS
  A total of 351 patients with mRCC at diagnosis recruited from 18 tertiary care centers who had been treated with systemic treatment were included in this retrospective study. OS was assessed by the Kaplan-Meier method according to the completion of a CN. The population was subsequently stratified according to MSKCC and ECOG prognostic groups.
  
  
  RESULTS
  Median OS in the entire cohort was 37.1 months. Median OS was significantly improved for patients who underwent CN (16.4 vs. 38.1 months, P<0.001). However, subgroup analysis demonstrated that OS improvement after CN was only significant among the patients with an ECOG score of 0 to 1 (16.7 vs. 43.3 months, P = 0.03) and the group of patients with good and intermediate MSKCC score (16.8 vs. 42.4 months, P = 0.02). On the contrary, this benefit was not significant for the patients with an ECOG score of 2 to 3 (8.0 vs. 12.6 months, P = 0.8) or the group with poor MSKCC score (5.2 vs. 5.2, P = 0.9).
  
  
  CONCLUSIONS
  CN improves OS in patients with mRCC. However, this effect does not seem to be significant for the patients in ECOG performance status groups of 2 to 3 or poor MSKCC prognostic group.
authors.affiliation: Department of Urology, Pontchaillou Hospital, Rennes University, Rennes, France.
authors.forename: Romain
authors.initials: R
authors.lastname: Mathieu
authors.affiliation: Department of Urology, Bicetre Hospital, Paris XI University, Le Kremlin Bicêtre, France. Electronic address: geraldine.pignot@bct.aphp.fr.
authors.forename: Géraldine
authors.initials: G
authors.lastname: Pignot
authors.affiliation: Department of Urology, Bicetre Hospital, Paris XI University, Le Kremlin Bicêtre, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Ingles
authors.affiliation: Department of Urology, Pontchaillou Hospital, Rennes University, Rennes, France.
authors.forename: Maxime
authors.initials: M
authors.lastname: Crepel
authors.affiliation: Department of Urology, Angers University Hospital, Angers, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Bigot
authors.affiliation: Departments of Urology and Oncology, Bordeaux University, Bordeaux, France.
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Bernhard
authors.affiliation: Department of Oncology, Centre François Baclesse, Caen, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Joly
authors.affiliation: Departments of Urology, Clermont-Ferrand University, Clermont-Ferrand, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Guy
authors.affiliation: Departments of Urology and Oncology, Bordeaux University, Bordeaux, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Ravaud
authors.affiliation: Department of Urology, Angers University Hospital, Angers, France.
authors.forename: Abdel Rahmene
authors.initials: AR
authors.lastname: Azzouzi
authors.affiliation: Department of Oncology, Institut Paoli-Calmettes, Marseille, France.
authors.forename: Gwenaelle
authors.initials: G
authors.lastname: Gravis
authors.affiliation: Department of Oncology, Institut Claudius Regaud, Toulouse University, Toulouse, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Chevreau
authors.affiliation: Department of Urology, Huriez Hospital, Lille Nord de France University, Lille, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Zini
authors.affiliation: Department of Urology, Strasbourg Hospital, University of Strasbourg, Strasbourg, France.
authors.forename: Hervé
authors.initials: H
authors.lastname: Lang
authors.affiliation: Department of Urology, Rouen University Hospital, Rouen, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Pfister
authors.affiliation: Department of Urology, La Conception Hospital, Marseille University, Marseille, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Lechevallier
authors.affiliation: Department of Urology, La Conception Hospital, Marseille University, Marseille, France.
authors.forename: Pierre-Olivier
authors.initials: PO
authors.lastname: Fais
authors.affiliation: Department of Urology, Dupuytren Hospital, Limoges University, Limoges, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Berger
authors.affiliation: Department of Urology, Hôtel Dieu Hospital, Nantes University, Nantes, France.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Vayleux
authors.affiliation: Department of Urology, Pitié Salpétrière Hospital, Paris VI University, Paris, France.
authors.forename: Morgan
authors.initials: M
authors.lastname: Roupret
authors.affiliation: Department of Urology, Pitié Salpétrière Hospital, Paris VI University, Paris, France.
authors.forename: François
authors.initials: F
authors.lastname: Audenet
authors.affiliation: Department of Urology, Dupuytren Hospital, Limoges University, Limoges, France.
authors.forename: Aurelien
authors.initials: A
authors.lastname: Descazeaud
authors.affiliation: Department of Urology, Hôtel Dieu Hospital, Nantes University, Nantes, France.
authors.forename: Jerome
authors.initials: J
authors.lastname: Rigaud
authors.affiliation: Department of Oncology, Cliniques Universitaires St-Luc, Louvain University, Brussels, Belgium.
authors.forename: Jean-Pascal
authors.initials: JP
authors.lastname: Machiels
authors.affiliation: Department of Urology, Ludwig-Maximilian-University of Munich, Munchen, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Staehler
authors.affiliation: Department of Urology, Henri Mondor Hospital, Paris XII University, Créteil, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Salomon
authors.affiliation: Departments of Urology and Oncology, Bordeaux University, Bordeaux, France.
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Ferriere
authors.affiliation: Department of Urology, Besancon University, Besancon, France.
authors.forename: Francois
authors.initials: F
authors.lastname: Kleinclauss
authors.affiliation: Department of Urology, Pontchaillou Hospital, Rennes University, Rennes, France.
authors.forename: Karim
authors.initials: K
authors.lastname: Bensalah
authors.affiliation: Department of Urology, Bicetre Hospital, Paris XI University, Le Kremlin Bicêtre, France.
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Patard
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009392:Nephrectomy / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D055815:Young Adult
keywords: Carcinoma; Nephrectomy; Renal cell; Survival