title: Benefit of on nephrectomy for treating metastatic renal cell carcinoma.
abstract: BACKGROUND
  Systemic treatment for metastatic renal cell carcinoma (mRCC) has changed with the new therapies, and it is not clear if nephrectomy (NEP) has a survival benefit in this kind of patients.
  
  
  OBJECTIVE
  To investigate if NEP associated to systemic treatment improves overall survival (OS) and progression-free survival (PFS).
  
  
  METHODS
  A retrospective, observational, descriptive study of 45 patients with diagnosis of mRCC between 2006-2014. Advanced cases with only palliative care were excluded, also patients with solitary metastasis who were managed with surgical resection.
  
  
  RESULTS
  Finally 34 patients were treated with systemic treatment. Twenty-six also with surgery associated. Seventy percent were intermediate/low risk at the Motzer classification and>80% Karnofsky performance status. PFS was 7m. NEP improves PFS (10 vs. 4m). High risk Motzer decreased PFS (P<.001). The OS was 11.5m. Patients with Karnofsky performance status>80, intermediate or low risk Motzer treated with NEP and mTOR as second line treatment, increased the OS (14 vs. 3m, P=.0001; 14 vs. 6m, P=.001; and 9 vs. 5m, P=.003, respectively). In the multivariate analysis only NEP (P=0,006; HR 4.5) and intermediate/low risk at the Motzer classification(P=.020; HR 8.9) demonstrated significant improvement in OS.
  
  
  CONCLUSIONS
  Patients treated with NEP associated to systemic treatment and with an intermediate/low risk in the Motzer classification had a better PFS and OS. The OS also improves in patients treated with mTOR in second line, and Karnofsky performance status>80%in the univariate study, but not in the multivariable one.
authors.affiliation: Servicios de Urología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España. Electronic address: cgruizleon@gmail.com.
authors.forename: C
authors.initials: C
authors.lastname: González-Ruiz de León
authors.affiliation: Servicios de Urología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España.
authors.forename: P
authors.initials: P
authors.lastname: Pellejero-Pérez
authors.affiliation: Servicios de Urología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España.
authors.forename: A
authors.initials: A
authors.lastname: Quintás-Blanco
authors.affiliation: Servicios de Urología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España.
authors.forename: J
authors.initials: J
authors.lastname: García-Rodríguez
authors.affiliation: Servicio de oncología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España.
authors.forename: C
authors.initials: C
authors.lastname: Álvarez-Fernández
authors.affiliation: Servicios de Urología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España.
authors.forename: J M
authors.initials: JM
authors.lastname: Fernández-Gómez
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D012189:Retrospective Studies; D015996:Survival Rate
keywords: Carcinoma renal metastásico; Clasificación de Motzer; Mestastatic renal cell carcinoma; Motzer classification; Nefrectomía; Nephrectomy