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Ocak B, Sahin AB, Ertürk I, Korkmaz M, Erdem D, Cakıroglu U, Karaca M, Dirican A, Olmez OF, Goktas Aydın S, Gökyer A, Kücükarda A, Gülmez A, Yumuk PF, Demircan NC, Oyman A, Sakalar T, Karatas F, Demir H, Yasin AI, Deligonul A, Dakiki B, Goktug MR, Avcı O, Tacar SY, Turhal NS, Deniz GI, Kacan T, Cubukcu E, Evrensel T. Can Cytoreductive Nephrectomy Improve Outcomes of Nivolumab Treatment in Patients with Metastatic Clear-Cell Renal Carcinoma? Curr Oncol 2024; 31:5195-5205. [PMID: 39330012 PMCID: PMC11431784 DOI: 10.3390/curroncol31090384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2024] [Revised: 08/27/2024] [Accepted: 08/29/2024] [Indexed: 09/28/2024] Open
Abstract
Background: This study aimed to investigate the effect of cytoreductive nephrectomy (CN) on the survival outcomes of nivolumab used as a subsequent therapy after the failure of at least one anti-vascular endothelial growth factor (VEGF) agent in patients with metastatic clear-cell renal-cell carcinoma (ccRCC). Methods: We included 106 de novo metastatic ccRCC patients who received nivolumab after progression on at least one anti-VEGF agent. Multivariate Cox regression analysis was performed to investigate the factors affecting survival in patients receiving nivolumab. Results: Of the 106 de novo metastatic ccRCC patients, 83 (78.3%) underwent CN. There were no statistical differences between the two groups in terms of age, gender, Eastern Cooperative Oncology Group (ECOG) score, tumor size, International Metastatic RCC Database Consortium (IMDC) risk group, number of previous treatment lines, first-line anti-VEGF therapy, or metastasis sites (p = 0.137, p = 0.608, p = 0.100, p = 0.376, p = 0.185, p = 0.776, p = 0.350, and p = 0.608, respectively). The patients who received nivolumab with CN had a longer time to treatment discontinuation (TTD) [14.5 months, 95% confidence interval (CI): 8.6-20.3] than did those without CN 6.7 months (95% CI: 3.9-9.5) (p = 0.001). The median overall survival (OS) was 22.7 months (95% CI: 16.1-29.4). The patients with CN had a median OS of 22.9 months (95% CI: 16.3-29.4), while those without CN had a median OS of 8.1 months (95% CI: 5.6-10.5) (p = 0.104). In the multivariate analysis, CN [hazard ratio (HR): 0.521; 95% CI: 0.297-0.916; p = 0.024] and the IMDC risk score (p = 0.011) were statistically significant factors affecting TTD; however, the IMDC risk score (p = 0.006) was the only significant factor for overall survival. Conclusions: Our study showed that the TTD of nivolumab was longer in metastatic ccRCC patients who underwent cytoreductive nephrectomy.
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Affiliation(s)
- Birol Ocak
- Department of Medical Oncology, Bursa Yuksek Ihtisas Training and Research Hospital, University of Health Sciences, Bursa 16350, Turkey;
| | - Ahmet Bilgehan Sahin
- Department of Medical Oncology, School of Medicine, Bursa Uludag University, Bursa 16059, Turkey; (A.B.S.); (A.D.); (B.D.); (M.R.G.); (E.C.); (T.E.)
| | - Ismail Ertürk
- Department of Medical Oncology, Gulhane School of Medicine, University of Health Sciences, Ankara 06018, Turkey;
| | - Mustafa Korkmaz
- Department of Medical Oncology, School of Medicine, Necmettin Erbakan University, Konya 42090, Turkey;
| | - Dilek Erdem
- Department of Medical Oncology, VM Medical Park Samsun Hospital, Samsun 55200, Turkey;
| | - Umut Cakıroglu
- Department of Medical Oncology, Van Training and Research Hospital, University of Health Sciences, Van 65300, Turkey;
| | - Mustafa Karaca
- Department of Medical Oncology, Antalya Training and Research Hospital, University of Health Sciences, Antalya 07100, Turkey;
| | - Ahmet Dirican
- Department of Medical Oncology, School of Medicine, Celal Bayar University, Manisa 45140, Turkey;
| | - Omer Fatih Olmez
- Department of Medical Oncology, Medipol University Hospital, Istanbul 34810, Turkey; (O.F.O.); (S.G.A.)
| | - Sabin Goktas Aydın
- Department of Medical Oncology, Medipol University Hospital, Istanbul 34810, Turkey; (O.F.O.); (S.G.A.)
| | - Ali Gökyer
- Department of Medical Oncology, Department of Internal Medicine, School of Medicine, Trakya University, Edirne 22130, Turkey; (A.G.); (A.K.)
| | - Ahmet Kücükarda
- Department of Medical Oncology, Department of Internal Medicine, School of Medicine, Trakya University, Edirne 22130, Turkey; (A.G.); (A.K.)
| | - Ahmet Gülmez
- Department of Medical Oncology, School of Medicine, Inonu University, Malatya 44280, Turkey;
| | - Perran Fulden Yumuk
- Department of Medical Oncology, School of Medicine, Marmara University, Istanbul 34854, Turkey; (P.F.Y.); (N.C.D.)
| | - Nazim Can Demircan
- Department of Medical Oncology, School of Medicine, Marmara University, Istanbul 34854, Turkey; (P.F.Y.); (N.C.D.)
| | - Abdilkerim Oyman
- Department of Medical Oncology, Umraniye Training and Research Hospital, University of Health Sciences, Istanbul 34764, Turkey;
| | - Teoman Sakalar
- Department of Medical Oncology, Necip Fazıl City Hospital, Kahramanmaraş 46050, Turkey
| | - Fatih Karatas
- Department of Medical Oncology, Faculty of Medicine, Karabuk University, Karabuk 78100, Turkey;
| | - Hacer Demir
- Department of Medical Oncology, Afyonkarahisar Health Sciences University, Afyon 03030, Turkey;
| | - Ayse Irem Yasin
- Department of Medical Oncology, Faculty of Medicine, Bezmialem Vakif University, Istanbul 34093, Turkey;
| | - Adem Deligonul
- Department of Medical Oncology, School of Medicine, Bursa Uludag University, Bursa 16059, Turkey; (A.B.S.); (A.D.); (B.D.); (M.R.G.); (E.C.); (T.E.)
| | - Bahar Dakiki
- Department of Medical Oncology, School of Medicine, Bursa Uludag University, Bursa 16059, Turkey; (A.B.S.); (A.D.); (B.D.); (M.R.G.); (E.C.); (T.E.)
| | - Mehmet Refik Goktug
- Department of Medical Oncology, School of Medicine, Bursa Uludag University, Bursa 16059, Turkey; (A.B.S.); (A.D.); (B.D.); (M.R.G.); (E.C.); (T.E.)
| | - Okan Avcı
- Department of Medical Oncology, Tekirdağ Namık Kemal University, Tekirdağ 34093, Turkey; (O.A.); (S.Y.T.)
| | - Seher Yildiz Tacar
- Department of Medical Oncology, Tekirdağ Namık Kemal University, Tekirdağ 34093, Turkey; (O.A.); (S.Y.T.)
| | - Nazım Serdar Turhal
- Department of Medical Oncology, Anadolu Health Center, Kocaeli 2255, Turkey;
| | - Gülhan Ipek Deniz
- Department of Medical Oncology, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul 34371, Turkey;
| | - Turgut Kacan
- Department of Medical Oncology, Bursa Yuksek Ihtisas Training and Research Hospital, University of Health Sciences, Bursa 16350, Turkey;
| | - Erdem Cubukcu
- Department of Medical Oncology, School of Medicine, Bursa Uludag University, Bursa 16059, Turkey; (A.B.S.); (A.D.); (B.D.); (M.R.G.); (E.C.); (T.E.)
| | - Türkkan Evrensel
- Department of Medical Oncology, School of Medicine, Bursa Uludag University, Bursa 16059, Turkey; (A.B.S.); (A.D.); (B.D.); (M.R.G.); (E.C.); (T.E.)
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Ditonno F, Bologna E, Licari LC, Franco A, Pettenuzzo G, Leonardo C, Proietti F, Carbonara U, Mir MC, Crivellaro S, Veccia A, Bertolo R, Antonelli A, Autorino R. Upfront versus deferred cytoreductive nephrectomy following targeted or immunotherapy: a population-based propensity score-matched analysis of perioperative complications. World J Urol 2024; 42:451. [PMID: 39066794 DOI: 10.1007/s00345-024-05156-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 06/27/2024] [Indexed: 07/30/2024] Open
Abstract
PURPOSE To evaluate the incidence of postoperative complications after cytoreductive nephrectomy (CN) following first-line treatment for metastatic renal cell carcinoma (mRCC), and to compare it with postoperative complications of upfront CN. METHODS For this population-based retrospective study, the PearlDiver Mariner database (PearlDiver Technologies, Colorado Springs, CO), a database of insurance billing records was analyzed. Using relevant ICD-9/10 and CPT codes, patients diagnosed with mRCC between 2011 and 2021, who received first-line systemic molecular therapy (SMT), either tyrosine kinase inhibitors (TKI) or immune-checkpoint inhibitors (ICI), were identified. The selected population was stratified into two cohorts according to the timing of CN (deferred: after SMT vs. upfront: before SMT). Propensity-score matching (PSM) was performed as per baseline patients' characteristics to control for potential confounders between the two cohorts. The primary outcome was to compare 30-day postoperative complications rate between patients undergoing upfront vs. deferred CN. RESULTS After PSM, 162 patients who received upfront CN were compared with 162 patients who underwent deferred CN. The overall rate of 30-day postoperative complications was statistically significantly higher in patients undergoing deferred CN (33.9%), compared to patients treated with upfront CN (21%, p < 0.01). In addition, the rate of both medical (26.5% vs. 14.2%, p < 0.01) and surgical (14.8 vs. 7.4%, p = 0.03) complication rate was statistically significantly higher in deferred vs. upfront CN. Multivariable logistic regression analysis revealed that none of the treatment regimens significantly predicted the occurrence of postoperative complications. CONCLUSION Patients undergoing deferred CN experience a higher rates of overall, medical, and surgical 30-day postoperative complications compared to those receiving upfront surgery. Findings from this study should be interpreted within the limitations of this type of analysis.
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Affiliation(s)
- Francesco Ditonno
- Department of Urology, Rush University Medical Center, 1725 W. Harrison Street, Suite 970, Chicago, IL, 60612, USA
- Department of Urology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy
| | - Eugenio Bologna
- Department of Urology, Rush University Medical Center, 1725 W. Harrison Street, Suite 970, Chicago, IL, 60612, USA
- Department of Maternal-Child and Urological Sciences, Sapienza University Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Leslie Claire Licari
- Department of Urology, Rush University Medical Center, 1725 W. Harrison Street, Suite 970, Chicago, IL, 60612, USA
- Department of Maternal-Child and Urological Sciences, Sapienza University Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Antonio Franco
- Department of Urology, Rush University Medical Center, 1725 W. Harrison Street, Suite 970, Chicago, IL, 60612, USA
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Greta Pettenuzzo
- Department of Urology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy
- Department of Urology, University of Illinois at Chicago, Chicago, IL, USA
| | - Costantino Leonardo
- Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy
| | - Flavia Proietti
- Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy
| | | | - M Carmen Mir
- Department of Urology, Hospital Universitario La Ribera, Valencia, Spain
| | - Simone Crivellaro
- Department of Urology, University of Illinois at Chicago, Chicago, IL, USA
| | - Alessandro Veccia
- Department of Urology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy
| | - Riccardo Bertolo
- Department of Urology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy
| | - Alessandro Antonelli
- Department of Urology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy
| | - Riccardo Autorino
- Department of Urology, Rush University Medical Center, 1725 W. Harrison Street, Suite 970, Chicago, IL, 60612, USA.
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Esdaille AR, Karam JA, Master VA, Spiess PE, Raman JD, Sharma P, Shapiro DD, Das A, Sexton WJ, Zemp L, Patil D, Allen GO, Matin SF, Wood CG, Abel EJ. Contemporary Patients Have Better Perioperative Outcomes Following Cytoreductive Nephrectomy: A Multi-institutional Analysis of 1272 Consecutive Patients. Urology 2023; 182:168-174. [PMID: 37690543 DOI: 10.1016/j.urology.2023.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 08/12/2023] [Accepted: 08/23/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVE To evaluate factors associated with perioperative outcomes in a multi-institutional cohort of patients treated with cytoreductive nephrectomy (CN). METHODS Data were analyzed for metastatic renal cell carcinoma patients treated with CN at 6 tertiary academic centers from 2005 to 2019. Outcomes included: Clavien-Dindo complications, mortality, length of hospitalization, 30-day readmission rate, and time to systemic therapy. Univariate and multivariable models evaluated associations between outcomes and prognostic variables including the year of surgery. RESULTS A total of 1272 consecutive patients were treated with CN. Patients treated in 2015-2019 vs 2005-2009 had better performance status (P<.001), higher pathologic N stage (P = .04), more frequent lymph node dissections (P<.001), and less frequent presurgical therapy (P = .02). Patients treated in 2015-2019 vs 2005-2009 had lower overall and major complications from surgery, 22% vs 39%, P<.001% and 10% vs 16%, P = .03. Mortality at 90days was higher for patients treated 2005-2009 vs 2015-2019; 10% vs 5%, P = .02. After multivariable analysis, surgical time period was an independent predictor of major complications and 90-day mortality following cytoreductive surgery. CONCLUSION Postoperative major complications and mortality rates following CN are significantly lower in patients treated within the most recent time period.
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Affiliation(s)
- Ashanda R Esdaille
- Department of Urology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI
| | - Jose A Karam
- Department of Urology, MD Anderson Cancer Center, Houston, TX; Department of Translational and Molecular Pathology, MD Anderson Cancer Center, Houston, TX
| | - Viraj A Master
- Department of Urology, Emory University and Winship Cancer Institute, Atlanta, GA
| | | | - Jay D Raman
- Department of Urology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA
| | - Pranav Sharma
- Department of Urology, Texas Tech University Health Sciences Center, Lubbock, TX
| | - Daniel D Shapiro
- Department of Urology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI
| | - Arighno Das
- Department of Urology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI
| | - Wade J Sexton
- Department of Urology, Emory University and Winship Cancer Institute, Atlanta, GA
| | - Logan Zemp
- Department of Urology, Emory University and Winship Cancer Institute, Atlanta, GA
| | - Dattatraya Patil
- Department of Urology, Emory University and Winship Cancer Institute, Atlanta, GA
| | - Glenn O Allen
- Department of Urology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI
| | - Surena F Matin
- Department of Urology, MD Anderson Cancer Center, Houston, TX
| | | | - Edwin Jason Abel
- Department of Urology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI.
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4
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Shapiro DD, Karam JA, Master VA, Zemp LW, Sexton WJ, Matin SF, Spiess PE, Jason Abel E. Reply to Alireza Ghoreifi and Hooman Djaladat's Letter to the Editor re: Daniel D. Shapiro, Jose A. Karam, Logan Zemp, et al. Cytoreductive Nephrectomy Following Immune Checkpoint Inhibitor Therapy Is Safe and Facilitates Treatment-free Intervals. Eur Urol Open Sci 2023;50:43-6. Eur Urol 2023; 84:e55-e56. [PMID: 37149462 DOI: 10.1016/j.eururo.2023.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 04/21/2023] [Indexed: 05/08/2023]
Affiliation(s)
- Daniel D Shapiro
- Department of Urology, The University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
| | - Jose A Karam
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Viraj A Master
- Department of Urology, Emory University Medical Center, Atlanta, GA, USA
| | - Logan W Zemp
- Department of Urology, Moffitt Cancer Center, Tampa, FL, USA
| | - Wade J Sexton
- Department of Urology, Moffitt Cancer Center, Tampa, FL, USA
| | - Surena F Matin
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - E Jason Abel
- Department of Urology, The University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Esdaille AR, Abel EJ. Evolution of risk stratification systems is critical for improving patient selection for cytoreductive nephrectomy. Cancer 2021; 127:3920-3923. [PMID: 34286855 DOI: 10.1002/cncr.33788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 06/21/2021] [Indexed: 11/10/2022]
Affiliation(s)
- Ashanda R Esdaille
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - E Jason Abel
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Okazaki A, Kijima T, Schiller P, Ishikawa N, Fuchizawa H, Takei K, Suzuki I, Sakamoto K, Tsuzuki T, Kamai T. Spontaneous regression of multiple pulmonary metastases accompanied by normalization of serum immune markers following cytoreductive nephrectomy in a patient with clear-cell renal cell carcinoma. IJU Case Rep 2021; 4:95-99. [PMID: 33718815 PMCID: PMC7924083 DOI: 10.1002/iju5.12252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 11/30/2020] [Accepted: 12/05/2020] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The spontaneous regression of metastases, which mostly occurs after surgical resection of the primary tumor, has been described in various malignancies, including renal cell carcinoma. The involvement of the host immune system is currently postulated as the underlying mechanism. CASE PRESENTATION We present a case of metastatic clear-cell renal cell carcinoma that achieved complete spontaneous regression of multiple pulmonary metastases preceded by normalization of serum immune markers after cytoreductive nephrectomy. The patient remained disease free for 3 years without any systemic therapy, suggesting that postoperative normalization of serum immune markers may indicate recovery of the host immune system, which prevents tumor recurrence. CONCLUSION Monitoring of serum immune markers may be useful to identify patients with recovered immune function and, therefore, may not require systemic therapy. Similarly, the case suggests a potential role of cytoreductive nephrectomy in the contemporary management of metastatic renal cell carcinoma.
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Affiliation(s)
- Akihito Okazaki
- Department of UrologyDokkyo Medical UniversityShimotsugaTochigiJapan
| | - Toshiki Kijima
- Department of UrologyDokkyo Medical UniversityShimotsugaTochigiJapan
| | - Philipp Schiller
- Department of UrologyDokkyo Medical UniversityShimotsugaTochigiJapan
| | - Natsumi Ishikawa
- Department of UrologyDokkyo Medical UniversityShimotsugaTochigiJapan
| | | | - Kohei Takei
- Department of UrologyDokkyo Medical UniversityShimotsugaTochigiJapan
| | - Issei Suzuki
- Department of UrologyDokkyo Medical UniversityShimotsugaTochigiJapan
| | - Kazumasa Sakamoto
- Department of UrologyDokkyo Medical UniversityShimotsugaTochigiJapan
| | - Toyonori Tsuzuki
- Department of Surgical PathologyAichi Medical University HospitalNagoyaAichiJapan
| | - Takao Kamai
- Department of UrologyDokkyo Medical UniversityShimotsugaTochigiJapan
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Tabakin AL, Stein MN, Anderson CB, Drake CG, Singer EA. Cytoreductive nephrectomy for metastatic renal cell carcinoma, the ultimate urologic 'Choosing Wisely' campaign: a narrative review. Transl Cancer Res 2020; 9:7337-7349. [PMID: 33354523 PMCID: PMC7751973 DOI: 10.21037/tcr-20-2343] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 10/21/2020] [Indexed: 01/04/2023]
Abstract
In the early 2000s, cytoreductive nephrectomy in addition to systemic cytokines became standard of care for treating metastatic renal cell carcinoma. Since that time, the development of novel systemic targeted therapies and immuno-oncologic agents have challenged the utility of cytoreductive nephrectomy in clinical practice. In 2019, the controversial CARMENA study was published, providing the first level one evidence suggesting that cytoreductive nephrectomy combined with targeted therapy yielded no survival advantage over targeted therapy alone in intermediate and poor risk metastatic renal cell carcinoma patients. Later that year, the SURTIME trial demonstrated that patients undergoing targeted therapy with delayed nephrectomy maintained a survival advantage over those that underwent upfront cytoreductive nephrectomy followed by targeted therapy. Both of these studies underscored the importance of patient selection and timing of cytoreductive nephrectomy and systemic therapy. As new immuno-oncologic agents are trialed, particularly in combination, the role of cytoreductive nephrectomy will continue to be questioned. In this narrative review, we discuss the evolution of the role of cytoreductive nephrectomy in treating metastatic renal cell carcinoma through the context of the ever-changing landscape of targeted therapies and immuno-oncologic agents. We assess the evidence for cytoreductive nephrectomy with respect to patient factors, timing of surgery, and combination with other therapies.
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Affiliation(s)
- Alexandra L. Tabakin
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08903, USA
| | - Mark N. Stein
- Division of Medical Oncology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA
| | - Christopher B. Anderson
- Department of Urology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA
| | - Charles G. Drake
- Division of Medical Oncology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA
| | - Eric A. Singer
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08903, USA
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Dr Hall B, Abel EJ. The Evolving Role of Metastasectomy for Patients with Metastatic Renal Cell Carcinoma. Urol Clin North Am 2020; 47:379-388. [PMID: 32600539 DOI: 10.1016/j.ucl.2020.04.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Surgical metastasectomy continues to be utilized for patients with solitary or low-volume metastatic renal cell carcinoma (mRCC). Although few high-quality data are available to evaluate outcomes, local treatment is recommended when feasible because it may allow a subset of patients to delay or avoid systemic treatments. With the development of improved mRCC therapies, utilization of metastasectomy has increased because most patients have incomplete responses to systemic treatment of their metastases. This review discusses the rationale and history of metastasectomy, trends in utilization, prognostic factors for patient selection, site-specific considerations, alternatives for nonsurgical local treatment, and risk of morbidity associated with metastasectomy.
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Affiliation(s)
- Bryan Dr Hall
- Department of Urology, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Madison, WI 53705, USA
| | - Edwin Jason Abel
- Department of Urology, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Madison, WI 53705, USA.
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Psutka SP. Personalizing preoperative risk stratification and refining patient selection for cytoreductive nephrectomy in metastatic renal cell carcinoma. Cancer 2020; 126:3912-3915. [PMID: 32515836 DOI: 10.1002/cncr.32993] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 05/11/2020] [Indexed: 12/30/2022]
Affiliation(s)
- Sarah P Psutka
- Department of Urology, University of Washington School of Medicine, Seattle, Washington
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Hsiang WR, Kenney PA, Leapman MS. Redefining the Role of Surgical Management of Metastatic Renal Cell Carcinoma. Curr Oncol Rep 2020; 22:35. [PMID: 32170461 DOI: 10.1007/s11912-020-0895-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW The treatment landscape for metastatic renal cell carcinoma (mRCC) continues to evolve with ongoing advancements in systemic therapy, raising further questions about the optimal role of surgery in the management of mRCC. Herein, we provide a context and review of the recent evidence concerning the role of surgical therapy for patients with mRCC including cytoreductive nephrectomy and distant metastatectomy. RECENT FINDINGS One randomized trial has been published in the targeted therapy era suggesting that initial systemic therapy is non-inferior to cytoreductive nephrectomy among patients with intermediate and poor-risk mRCC. Delaying cytoreductive nephrectomy until after systemic therapy may be a viable treatment approach, although a high level of evidence is lacking. Additional questions remain regarding the sequence of surgery with systemic therapy, utility of distant metastatectomy, as well as the application of these findings to the current generation of immunotherapy. Recent evidence challenges the need of upfront cytoreductive nephrectomy for unselected patients with mRCC. However, surgical therapy continues to play an important role in the management of the disease.
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Affiliation(s)
| | - Patrick A Kenney
- Yale University School of Medicine, New Haven, USA
- Department of Urology, Yale University School of Medicine, New Haven, USA
| | - Michael S Leapman
- Yale University School of Medicine, New Haven, USA.
- Department of Urology, Yale University School of Medicine, New Haven, USA.
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