title: Prognostic value of cytoreductive nephrectomy combined with targeted therapy for metastatic renal cell carcinoma: a meta-analysis.
abstract: OBJECTIVE
  The role of cytoreductive nephrectomy (CN) has been controversial with the advent of targeted therapy. Our study was to identify the prognostic value of CN combined with targeted therapy for treatment of metastatic renal cell carcinoma (mRCC) by conducting a meta-analysis based on the existing population-based studies.
  
  
  METHODS
  Research articles published up to September 2015 were searched through PubMed and Embase. A meta-analysis was performed to assess the overall survival (OS) and progression-free survival (PFS) of patients with mRCC undergoing CN combined with targeted therapy compared with targeted therapy alone. Furthermore, analysis was made to evaluate some potential prognostic factors predicting survival.
  
  
  RESULTS
  Eight studies were included in our analysis with 2688 mRCC patients. A fixed-effect model was performed and found the pooled HR of OS was 0.60 (95 % CI 0.53-0.67, p < 0.0001). Furthermore, the pooled median survival ratio was elevated (HR 2.11, 95 % CI 1.78-2.49, p < 0.0001), indicating that patients who received CN combined with targeted therapy yielded a more than twofold prolonged OS compared with those who received targeted therapy alone. Moreover, no significant difference was observed in PFS in the patients undergoing CN combined with targeted therapy (HR 0.82, 95 % CI 0.57-1.19, p = 0.30).
  
  
  CONCLUSIONS
  Current evidence suggests that CN combined with targeted therapy has a significant OS advantage in patients with mRCC. However, the results should be evaluated in the context of the potential selection biases of the existing evidence. Large prospective cohort studies are required to confirm these findings.
authors: Department of Urology, Nanfang Hospital, Southern Medical University, No. 1838, North of Guangzhou Avenue, Guangzhou, 510515, Guangdong Province, People's Republic of China.
authors: Xuwei
authors: X
authors: Hong
authors: Department of Urology, Nanfang Hospital, Southern Medical University, No. 1838, North of Guangzhou Avenue, Guangzhou, 510515, Guangdong Province, People's Republic of China.
authors: Fei
authors: F
authors: Li
authors: Department of Urology, Nanfang Hospital, Southern Medical University, No. 1838, North of Guangzhou Avenue, Guangzhou, 510515, Guangdong Province, People's Republic of China.
authors: Kaiqiang
authors: K
authors: Tang
authors: Department of Urology, Nanfang Hospital, Southern Medical University, No. 1838, North of Guangzhou Avenue, Guangzhou, 510515, Guangdong Province, People's Republic of China.
authors: Shiyu
authors: S
authors: Pang
authors: Department of Urology, Nanfang Hospital, Southern Medical University, No. 1838, North of Guangzhou Avenue, Guangzhou, 510515, Guangdong Province, People's Republic of China.
authors: Guangzheng
authors: G
authors: Lin
authors: Department of Urology, Nanfang Hospital, Southern Medical University, No. 1838, North of Guangzhou Avenue, Guangzhou, 510515, Guangdong Province, People's Republic of China.
authors: Shi
authors: S
authors: Li
authors: Department of Urology, Nanfang Hospital, Southern Medical University, No. 1838, North of Guangzhou Avenue, Guangzhou, 510515, Guangdong Province, People's Republic of China.
authors: Jiming
authors: J
authors: Bao
authors: Department of Urology, Nanfang Hospital, Southern Medical University, No. 1838, North of Guangzhou Avenue, Guangzhou, 510515, Guangdong Province, People's Republic of China. twl@smu.edu.cn.
authors: Wanlong
authors: W
authors: Tan
mesh_terms: D002292:Carcinoma, Renal Cell / Q000556:secondary* / Q000628:therapy*; D003131:Combined Modality Therapy; D065426:Cytoreduction Surgical Procedures; D006801:Humans; D007680:Kidney Neoplasms / Q000556:secondary / Q000628:therapy*; D058990:Molecular Targeted Therapy; D009392:Nephrectomy
keywords: Meta-analysis; Molecular targeted therapy; Nephrectomy; Prognosis; Renal cell carcinoma