Complete Surgical Metastasectomy for Renal Cell Carcinoma in the Post-cytokine Era
Lyon TD, Thompson RH, Shah PH, et al.
Journal of Urology, August 2019
Data supporting complete metastasectomy (CM) for metastatic renal cell carcinoma (RCC) is derived primarily from the era of cytokine therapy, and whether CM remains beneficial among patients receiving more recently approved systemic therapies has not been well studied. The objective of this study was to examine survival outcomes among patients treated with CM in the era of targeted therapy and checkpoint blockade availability.
We queried our institutional nephrectomy registry to identify 586 patients who underwent partial or radical nephrectomy for unilateral, sporadic RCC with a first occurrence of metastases between 2006 and 2017, including 158 treated with CM. Associations of CM with cancer-specific and overall survival were assessed using Cox proportional hazards models.
Median follow-up after diagnosis of metastases was 3.9 years, during which time 403 patients died, including 345 from RCC. Of the CM patients, 147 (93%) did not receive any systemic treatment for their index metastatic lesion(s). Two-year CSS was significantly greater for patients with CM than for those without (84% vs. 54%, p<0.001). After adjusting for age, sex, and the timing, number, and location of metastases, CM was associated with a significantly reduced likelihood of death from RCC (HR 0.47, 95% CI 0.34-0.65, p<0.001).
Complete surgical resection of metastases from RCC is associated with improved CSS in the post-cytokine era and may be considered for appropriate patients following a process of shared decision-making.