title: The role of cytoreductive surgery in the era of targeted agents.
abstract: OBJECTIVE
  Two randomized trials were initiated to define the role and sequence of cytoreductive nephrectomy in combination with VEGF-targeted therapy for metastatic renal cell cancer. While these trials will not report before the end of 2016, recent retrospective population-based studies published real-world data on incidence, treatment, prognosis and outcome that may help to better define the role of cytoreductive nephrectomy for this heterogeneous patient population in the targeted therapy era.
  
  
  RESULTS
  Since the introduction of targeted agents, utilization of cytoreductive nephrectomy has declined. Potentially more patients are being treated with their primary tumours in place. Some countries also observed an additional decline in the incidence of primary metastatic disease. Although large population-based studies consistently demonstrate a survival benefit after cytoreductive nephrectomy, confounding factors preclude definite conclusions. However, patients with a life expectancy of less than 1 year or at least four IMDS risk factors may not benefit from cytoreductive nephrectomy.
  
  
  CONCLUSIONS
  Recent retrospective data suggest a more refined use of cytoreductive nephrectomy in the targeted therapy era. With the exception of patients in whom cytoreductive nephrectomy and resection of solitary or oligometastasis may result in cure or delay of systemic therapy, performance, prognostic models and life expectancy estimates help to define the role of cytoreductive nephrectomy in the individual patient.
authors.affiliation: aThe Netherlands Cancer Institute, Department of Urology, Amsterdam, The Netherlands bEdinburgh Urological Cancer Group, Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital, Edinburgh, UK.
authors.forename: Allard
authors.initials: A
authors.lastname: Noe
authors.forename: Grant D
authors.initials: GD
authors.lastname: Stewart
authors.forename: Axel
authors.initials: A
authors.lastname: Bex
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000378:metabolism; D002292:Carcinoma, Renal Cell / Q000378:metabolism / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D065426:Cytoreduction Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D015994:Incidence; D007680:Kidney Neoplasms / Q000378:metabolism / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D058990:Molecular Targeted Therapy; D020360:Neoadjuvant Therapy; D009392:Nephrectomy / Q000009:adverse effects / Q000401:mortality; D015398:Signal Transduction / Q000187:drug effects; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D014408:Biomarkers, Tumor