Cytoreductive Nephrectomy — Patient Selection Is Key

Motzer RJ, Russo P.
N Engl J Med 2018; 379:481-482
DOI: 10.1056/NEJMe1806331

Metastatic renal-cell carcinoma has diverse clinical presentations ranging from incidental detection to a highly symptomatic systemic illness. Patients with metastatic renal-cell carcinoma are assigned a risk category — favorable, intermediate, or poor — on the basis of two published models containing five or six pretreatment selection factors, including presence of anemia, elevated serum calcium concentration, and degree of disability from cancer-related symptoms (performance status). This stratification provides important prognostic insight about whether patients should be treated with cytoreductive radical nephrectomy, systemic therapies, or both. Nephrectomy for stage IV disease removes the primary kidney tumor and its potential for bleeding and…

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