title: Cytoreductive nephrectomy with thrombectomy before targeted therapy improves survival for metastatic renal cell carcinoma with venous tumor thrombus: a single-center experience.
abstract: BACKGROUND
  The aim of the study is to evaluate the role of cytoreductive nephrectomy (CN) with thrombectomy before targeted molecular therapy (TMT) on survival in metastatic renal cell carcinoma (mRCC) with venous tumor thrombus.
  
  
  METHODS
  We performed a retrospective analysis of 47 patients treated in our center from April 2008 to October 2014. In the study, 20 patients underwent CN with thrombectomy followed by targeted therapy (group 1); 15 patients received targeted therapy alone (group 2); and 12 patients underwent CN with thrombectomy alone (group 3). The overall survival (OS) and cancer-specific survival (CSS) were calculated according to the Kaplan-Meier survival curve method, and prognostic variables were assessed by Cox regression analyses.
  
  
  RESULTS
  The median follow-up times of group 1, group 2, and group 3 were 24.5, 12, and 6.5 months, respectively. During follow-up, in both group 1 and group 3, 12 patients died. In group 2, 14 patients died. The median OS of group 1, group 2, and group 3 was 22, 12, and 6 months, respectively (P < 0.001). Compared with surgery alone and targeted therapy alone, patients with cytoreductive surgery before targeted therapy had statistically better survival benefits (P < 0.001, P = 0.009, respectively). On univariate analysis, the number of metastatic sites (P = 0.004) was a statistically significant prognostic factor influencing OS.
  
  
  CONCLUSIONS
  Our single-center experience showed that CN with thrombectomy before targeted therapy improved the survival of patients with mRCC with venous tumor thrombus. The number of metastatic sites was an independent prognostic factor influencing OS.
authors.affiliation: Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, Beijing, China.
authors.forename: Nienie
authors.initials: N
authors.lastname: Qi
authors.affiliation: Department of Urology, Beijing Hospital, Beijing, China.
authors.forename: Pengjie
authors.initials: P
authors.lastname: Wu
authors.affiliation: Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, Beijing, China.
authors.forename: Jinchao
authors.initials: J
authors.lastname: Chen
authors.affiliation: Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, Beijing, China.
authors.forename: Teng
authors.initials: T
authors.lastname: Li
authors.affiliation: Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, Beijing, China.
authors.forename: Xianghui
authors.initials: X
authors.lastname: Ning
authors.affiliation: Department of cardiac surgery, Peking University First Hospital, Beijing, China.
authors.forename: Jin
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Urology, Peking University First Hospital, Institute of Urology, Peking University; National Urological Cancer Center, No. 8, Xishiku St., Xicheng Dist, Beijing, 100034, China. gongkan_pku@126.com.
authors.forename: Kan
authors.initials: K
authors.lastname: Gong
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002292:Carcinoma, Renal Cell / Q000401:mortality* / Q000556:secondary / Q000628:therapy; D003131:Combined Modality Therapy; D065426:Cytoreduction Surgical Procedures / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D058990:Molecular Targeted Therapy / Q000401:mortality*; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000401:mortality*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D017131:Thrombectomy / Q000401:mortality*; D013927:Thrombosis / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D014682:Vena Cava, Inferior / Q000473:pathology; D055815:Young Adult
keywords: Cytoreductive surgery; Metastasis; Renal cell carcinoma; Targeted molecular therapy; Venous tumor thrombus