Nephrectomy improves overall survival in patients with metastatic renal cell carcinoma in cases of favorable MSKCC or ECOG prognostic features.

Abstract

OBJECTIVES:

The role of cytoreductive nephrectomy (CN) in the treatment of patients harboring metastatic renal cell carcinoma (mRCC) has become controversial since the emergence of effective targeted therapies. The aim of our study was to compare the overall survival (OS) between CN and non-CN groups of patients presenting with mRCC in the era of targeted drugs and to assess these outcomes among the different Memorial Sloan-Kettering Cancer Center (MSKCC) and The Eastern Cooperative Oncology Group (ECOG) performance status subgroups.

METHODS AND MATERIALS:

A total of 351 patients with mRCC at diagnosis recruited from 18 tertiary care centers who had been treated with systemic treatment were included in this retrospective study. OS was assessed by the Kaplan-Meier method according to the completion of a CN. The population was subsequently stratified according to MSKCC and ECOG prognostic groups.

RESULTS:

Median OS in the entire cohort was 37.1 months. Median OS was significantly improved for patients who underwent CN (16.4 vs. 38.1 months, P<0.001). However, subgroup analysis demonstrated that OS improvement after CN was only significant among the patients with an ECOG score of 0 to 1 (16.7 vs. 43.3 months, P = 0.03) and the group of patients with good and intermediate MSKCC score (16.8 vs. 42.4 months, P = 0.02). On the contrary, this benefit was not significant for the patients with an ECOG score of 2 to 3 (8.0 vs. 12.6 months, P = 0.8) or the group with poor MSKCC score (5.2 vs. 5.2, P = 0.9).

CONCLUSIONS:

CN improves OS in patients with mRCC. However, this effect does not seem to be significant for the patients in ECOG performance status groups of 2 to 3 or poor MSKCC prognostic group.

• Authors: Romain Mathieu, Géraldine Pignot, Alexandre Ingles, Maxime Crepel, Pierre Bigot, Jean-Christophe Bernhard, Florence Joly, Laurent Guy, Alain Ravaud, Abdel Rahmene Azzouzi, Gwenaelle Gravis, Christine Chevreau, Laurent Zini, Hervé Lang, Christian Pfister, Eric Lechevallier, Pierre-Olivier Fais, Julien Berger, Bertrand Vayleux, Morgan Roupret, François Audenet, Aurelien Descazeaud, Jerome Rigaud, Jean-Pascal Machiels, Michael Staehler, Laurent Salomon, Jean-Marie Ferriere, Francois Kleinclauss, Karim Bensalah, Jean-Jacques Patard
• Journal: Urologic oncology (Urol Oncol) Vol. 33 Issue 8 Pg. 339.e9-15 (Aug 2015) ISSN: 1873-2496 [Electronic] United States
• PMID: 26087971 (Publication Type: Journal Article)
• Copyright: Copyright © 2015 Elsevier Inc. All rights reserved.

Topics

• Adult
• Aged
• Aged, 80 and over
• Carcinoma, Renal Cell (mortality, pathology, surgery)
• Cohort Studies
• Female
• Humans
• Kidney Neoplasms (mortality, pathology, surgery)
• Male
• Middle Aged
• Neoplasm Metastasis
• Nephrectomy (methods)
• Prognosis
• Retrospective Studies
• Survival Analysis
• Young Adult