title: Validation of preoperative variables and stratification of patients to help predict benefit of cytoreductive nephrectomy in the targeted therapy ERA.
abstract: OBJECTIVE
  To further elucidate which patients with metastatic renal cell carcinoma (mRCC) may benefit from cytoreductive nephrectomy (CN) before targeted therapy (TT), and to assess the overall survival of patients undergoing CN and TT versus TT alone.
  
  
  METHODS
  We identified 88 patients who underwent CN at our institution prior to planned TT and 35 patients who received TT without undergoing CN. Preoperative risk factors described in the literature were assessed in our patient population (serum albumin, liver metastasis, symptomatic metastasis, clinical ≥T3 disease, retroperitoneal and supradiaphragmatic lymphadenopathy). Patients were stratified by number of pretreatment risk factors and overall survival (OS) was compared.
  
  
  RESULTS
  TT patients had significantly more risk factors compared to CN patients (3.06 vs. 2.11, p<0.01). Patients who received TT alone had median OS of 5.8 months. All but one patient receiving TT alone had two or more risk factors. A comparison of the CN and TT groups was performed by constructing Kaplan-Meier curves. There was no significant difference in median OS for those patients with exactly two risk factors (447 vs. 389 days, p=0.24), and those with three or more risk factors (184 vs. 155 days, p=0.87).
  
  
  CONCLUSIONS
  Using previously described pretreatment risk factors we found that patients with two or more risk factors derived no significant survival advantage from CN in the TT era. These risk factors should be incorporated in the assessment of patients for CN.
authors.affiliation: Washington University School of Medicine, Division of Urology, St. Louis, Missouri, USA.
authors.forename: Brandon J
authors.initials: BJ
authors.lastname: Manley
authors.affiliation: Washington University School of Medicine, Division of Urology, St. Louis, Missouri, USA.
authors.forename: Eric H
authors.initials: EH
authors.lastname: Kim
authors.affiliation: Washington University School of Medicine, Division of Urology, St. Louis, Missouri, USA.
authors.forename: Joel M
authors.initials: JM
authors.lastname: Vetter
authors.affiliation: Washington University School of Medicine, Division of Urology, St. Louis, Missouri, USA.
authors.forename: Aaron M
authors.initials: AM
authors.lastname: Potretzke
authors.affiliation: Washington University School of Medicine, Division of Urology, St. Louis, Missouri, USA.
authors.forename: Seth A
authors.initials: SA
authors.lastname: Strope
mesh_terms: D002292:Carcinoma, Renal Cell / Q000556:secondary / Q000628:therapy*; D003131:Combined Modality Therapy; D065426:Cytoreduction Surgical Procedures; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000628:therapy*; D008875:Middle Aged; D058990:Molecular Targeted Therapy; D009392:Nephrectomy / Q000379:methods; D011300:Preoperative Care; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Carcinoma, Renal Cell ; Kidney Neoplasms; Nephrectomy