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After Cytoreductive Nephrectomy: When Is More Treatment of Benefit?

By: Julia Fiederlein
Posted: Thursday, February 11, 2021

Jack Rogers Andrews, MD, of the Mayo Clinic, Rochester, Minnesota, and colleagues performed an analysis to evaluate the outcomes of patients with de novo synchronous metastatic renal cell carcinoma who underwent cytoreductive nephrectomy and initial surveillance, with or without metastasis-directed therapy, and without planned immediate postoperative systemic therapy. The results presented during the virtual edition of the 2020 Society of Urologic Oncology (SUO) Annual Meeting (Abstract 83) may help determine which patients may benefit from upfront cytoreductive nephrectomy.

“Among appropriately selected patients managed with surveillance or metastasis-directed therapy after cytoreductive nephrectomy, approximately half are estimated to be alive and not requiring systemic therapy at 1 year, with a subset achieving long-term systemic therapy–free survival,” the investigators remarked. “Having a single metastatic site and disease amenable to complete metastasectomy are features associated with improved systemic therapy–free survival and overall survival after upfront cytoreductive nephrectomy.”

Using data from the Mayo Clinic Nephrectomy Registry, the investigators identified 156 patients with unilateral, sporadic, metastatic renal cell carcinoma who underwent upfront cytoreductive nephrectomy. Patients who received postoperative systemic therapy within 3 months of cytoreductive nephrectomy were excluded. Metastases were managed with surveillance alone (24%) or metastasis-directed therapy (76%).

A total of 72 patients initiated systemic therapy at a median of 0.7 years after the start date. At 1, 3, and 5 years after the start date, the rates of systemic therapy–free survival were 47%, 21%, and 14%, respectively; overall survival rates were 69%, 37%, and 28%, respectively. Based on the multivariable analysis, having multiple metastatic sites appeared to be associated with worse systemic therapy–free survival (hazard ratio = 1.85; P = .002). Patients who underwent a complete metastasectomy seemed to experience improved overall survival (hazard ratio = 0.59; P = .008).

Disclosure: No information regarding conflicts of interest was provided.



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