The independent oncological role for cytoreductive nephrectomy in metastatic renal cell carcinoma: Prognostic features in the era of targeted therapies.
To describe the effects of cytoreductive nephrectomy (CN) on the natural course of metastatic renal cell carcinoma (mRCC). CN appears to stabilize metastatic lesions in mRCC in a subgroup of patients and we hypothesize that systemic treatment might be deferred in these patients with stable disease after CN.



Overall, 45 patients with mRCC who underwent CN and subsequent oncologic follow-up were included in this retrospective, single-center analysis. After CN, patients were followed at least every 3 months with clinical evaluation, contrast-enhanced computerized tomography scan of chest and abdomen, with additional imaging if needed. At 3 months, patients were radiographically evaluated and categorized into nonresponders (death or progression) or responders (stable disease or remission). Kaplan-Meier and Cox proportional hazards regression statistics were used to describe prognostic factors for overall survival (OS) and systemic therapy-free survival (STFS).



Median OS was 31(3-121) months. Further, 24 (53.3%) and 21 (46.7%) patients were classified as responders and nonresponders at 3 months, respectively. Responders had a significant better 2-year OS compared with nonresponders (81.7% vs. 26.5%, P = 0.005). Responders also had a better 2-year STFS (40.3% vs. 6.3%, P = 0.005). On Cox regression analysis, worse OS was found to be associated with low preoperative hemoglobin levels, the absence of postoperative radiographical response, and the presence of non-clear cell pathology. The presence of postoperative radiographical response, normal preoperative lactate dehydrogenase levels, the presence of a single metastasis, and performing metastasis-directed therapy was found to be associated with a longer systemic therapy-free period.



A beneficial oncologic response is observed in approximately half of the patients undergoing CN. Absence of radiographic progression at 3 months is an important marker for OS and STFS. Therefore, systemic treatment might be postponed in selected patients.
Department of Urology, Ghent University Hospital, Gent, Belgium. Electronic address: tom.claeys@uzgent.be.
Tom
T
Claeys
Department of Urology, Ghent University Hospital, Gent, Belgium.
Nicolaas
N
Lumen
Department of Urology, Ghent University Hospital, Gent, Belgium.
Candy
C
Kumps
Department of Pathology, Ghent University Hospital, Gent, Belgium.
Marleen
M
Praet
Department of Radiotherapy, Ghent University Hospital, Gent, Belgium.
Gert
G
De Meerleer
Department of Oncology, Ghent University Hospital, Gent, Belgium.
Sylvie
S
Rottey
Department of Radiotherapy, Ghent University Hospital, Gent, Belgium.
Piet
P
Ost
Department of Radiology, Ghent University Hospital, Gent, Belgium.
Pieter
P
Devisschere
Department of Radiology, Ghent University Hospital, Gent, Belgium.
Geert
G
Villeirs
Department of Radiotherapy, Ghent University Hospital, Gent, Belgium.
Valerie
V
Fonteyne
Department of Urology, Ghent University Hospital, Gent, Belgium.
Karel
K
Decaestecker
D000368:Aged; D002292:Carcinoma, Renal Cell / Q000556:secondary / Q000601:surgery*; D065426:Cytoreduction Surgical Procedures / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000401:mortality*; D018579:Patient Selection; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate
Cytoreductive surgery; Metastasis; Nephrectomy; Renal cell carcinoma