PURPOSE: We evaluated the value of cytoreductive nephrectomy in patients with metastatic renal cell carcinoma in the targeted therapy era. MATERIALS AND METHODS: We reviewed the records of 78 patients treated with targeted therapy for metastatic renal cell carcinoma between 2006 and 2009. A total of 45 patients underwent cytoreductive nephrectomy followed by targeted therapy (cytoreductive nephrectomy group) and 33 were treated with targeted therapy alone (noncytoreductive nephrectomy group). We estimated progression-free and overall survival using Kaplan-Meier curves. The prognostic significance of each variable was estimated with a Cox proportional hazards regression model. RESULTS: Clinicopathological variables did not differ in the 2 groups except for Karnofsky performance status and sarcomatoid feature. The treatment response rate did not differ in the 2 groups (23.1% vs 30.3%, p = 0.488). Median progression-free survival was 11.7 and 9.0 months in the cytoreductive and noncytoreductive nephrectomy groups (p = 0.270), and median overall survival was 21.6 and 13.9 months, respectively (p = 0.128). On multivariate analysis Karnofsky performance status (HR 2.9, 95% CI 1.4-5.7, p = 0.003) and sarcomatoid features (HR 2.9, 95% 1.3-6.7, p = 0.013) were independent predictors of progression-free survival. Karnofsky performance status (HR 3.3, 95% 1.7-6.5, p = 0.001), sarcomatoid features (HR 2.7, 95% 1.2-6.2, p = 0.021) and liver metastasis (HR 2.7, 95% 1.0-7.1, p = 0.045) were independent predictors of overall survival. CONCLUSIONS: We found no significant differences in tumor response or survival between the 2 groups. Prospective trials are needed to confirm our results.
PURPOSE: We evaluated the value of cytoreductive nephrectomy in patients with metastatic renal cell carcinoma in the targeted therapy era. MATERIALS AND METHODS: We reviewed the records of 78 patients treated with targeted therapy for metastatic renal cell carcinoma between 2006 and 2009. A total of 45 patients underwent cytoreductive nephrectomy followed by targeted therapy (cytoreductive nephrectomy group) and 33 were treated with targeted therapy alone (noncytoreductive nephrectomy group). We estimated progression-free and overall survival using Kaplan-Meier curves. The prognostic significance of each variable was estimated with a Cox proportional hazards regression model. RESULTS: Clinicopathological variables did not differ in the 2 groups except for Karnofsky performance status and sarcomatoid feature. The treatment response rate did not differ in the 2 groups (23.1% vs 30.3%, p = 0.488). Median progression-free survival was 11.7 and 9.0 months in the cytoreductive and noncytoreductive nephrectomy groups (p = 0.270), and median overall survival was 21.6 and 13.9 months, respectively (p = 0.128). On multivariate analysis Karnofsky performance status (HR 2.9, 95% CI 1.4-5.7, p = 0.003) and sarcomatoid features (HR 2.9, 95% 1.3-6.7, p = 0.013) were independent predictors of progression-free survival. Karnofsky performance status (HR 3.3, 95% 1.7-6.5, p = 0.001), sarcomatoid features (HR 2.7, 95% 1.2-6.2, p = 0.021) and liver metastasis (HR 2.7, 95% 1.0-7.1, p = 0.045) were independent predictors of overall survival. CONCLUSIONS: We found no significant differences in tumor response or survival between the 2 groups. Prospective trials are needed to confirm our results.
Authors: Ross J Mason; Lori Wood; Anil Kapoor; Naveen Basappa; George Bjarnason; Stephen A Boorjian; Rodney H Breau; Ilias Cagiannos; Michael A S Jewett; Pierre I Karakiewicz; Wassim Kassouf; Christian Kollmannsberger; Aly-Khan A Lalani; Jean-Baptiste Lattouf; Luke T Lavallée; Stephen Pautler; Nicholas Power; Patrick Richard; Alan So; Simon Tanguay; Ricardo A Rendon Journal: Can Urol Assoc J Date: 2019-06 Impact factor: 1.862
Authors: Che-kai Tsao; Alexander C Small; Max Kates; Erin L Moshier; Juan P Wisnivesky; Benjamin A Gartrell; Guru Sonpavde; James H Godbold; Michael A Palese; Simon J Hall; William K Oh; Matthew D Galsky Journal: World J Urol Date: 2012-12-08 Impact factor: 4.226
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