Abstract
Purpose
To evaluate the prognostic role of cytoreductive nephrectomy (CN) in patients with
synchronous metastatic renal-cell carcinoma (mRCC).
Patients and Methods
We analyzed the electronic medical records of 294 patients with synchronous mRCC treated
at Samsung Medical Center from January 2005 to December 2015. Primary and secondary
end points were overall survival (OS) and cancer-specific survival (CSS), respectively.
OS and CSS were estimated by the Kaplan-Meier method and compared between patients
with and without CN, particularly by performing 1:1 propensity score matching. Multivariate
Cox regression analysis was used to identify independent predictors of survival outcomes.
Results
Among the overall population of synchronous mRCC patients, 189 patients (64.3%) underwent
CN. Compared to mRCC patients without CN, those who underwent CN have a higher proportion
of single metastasis (63.0% vs. 32.4%) and clear-cell histology (87.8% vs. 72.4%).
In the matched cohort, the patients who underwent CN had better OS and CSS outcomes
compared to those who did not undergo CN (median OS, 23.0 months vs. 11.0 months;
P < .001; median CSS, 34.0 months vs. 14.0 months; P < .001). On multivariable analysis, undergoing CN, body mass index, and Heng risk
score were found as significant predictive factors of both OS and CSS. In subgroup
analyses stratified by Heng risk criteria, the patients who received CN had better
OS and CSS in all risk groups.
Conclusion
CN significantly improved survival outcomes in synchronous mRCC patients treated with
targeted therapies and independently associated with prolonged survival, regardless
of Heng risk criteria.
Keywords
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Article info
Publication history
Published online: August 10, 2018
Accepted:
July 30,
2018
Received in revised form:
July 24,
2018
Received:
May 11,
2018
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
