Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2021 Jul;32(7):675-680.
doi: 10.1007/s10552-021-01435-z. Epub 2021 May 8.

Association between cytoreductive nephrectomy and survival among patients with metastatic renal cell carcinoma receiving modern therapies: a systematic review and meta-analysis examining effect modification according to systemic therapy approach

Mary E Hall  1 , Bimal Bhindi  2   3 , Amy N Luckenbaugh  1 , Aaron A Laviana  1 , Kelvin A Moses  1 , Raj Satkunasivam  4   5 , Brian Rini  6 , Zachary Klaassen  7   8 , Christopher J D Wallis  9
Affiliations
Meta-Analysis

Association between cytoreductive nephrectomy and survival among patients with metastatic renal cell carcinoma receiving modern therapies: a systematic review and meta-analysis examining effect modification according to systemic therapy approach

Mary E Hall et al. Cancer Causes Control. 2021 Jul.

Abstract

Purpose: Cytoreductive nephrectomy (CN) has played a role in treatment of metastatic renal cell carcinoma (mRCC) since trials demonstrated a survival benefit in patients receiving CN with interferon. With the publication of CARMENA, it became clear that the value of CN may depend on the co-therapy administered. We sought to assess the benefit of CN in the era of modern immunotherapy (IO).

Methods: We performed a systematic review to identify studies assessing CN in patients receiving TT or IO. We extracted multivariable-adjusted hazard ratios for the association between CN and overall survival (OS) and performed random effects meta-analysis. We tested for effect modification by systemic therapy approach on the association between CN and OS by pooling the difference in logHR associated with CN for patients treated with TT versus IO.

Results: We identified three comparisons assessing CN in patients receiving TT or IO. Pooled analysis indicated improved survival with CN in both the TT (2 cohorts, pooled HR: 0.52, 95% CI 0.46-0.59; I2 = 80%) and IO era (2 cohorts; pooled HR: 0.28, 95% CI 0.16-0.49; I2 = 21%), with a stronger association in the IO era (p = 0.01; I2 = 0%).

Conclusion: In observational datasets, we observed a larger survival benefit to CN in patients treated with IO-based regimens versus those treated with TT-based regimens. While the role of CN for patients receiving TT has recently been questioned, this suggests that the results of CARMENA do not necessarily preclude a benefit to CN when combined with IO-based regimens.

Keywords: Cytoreductive nephrectomy; Immunotherapy; Kidney cancer; Renal cell carcinoma.

PubMed Disclaimer

References

    1. Flanigan RC, Mickisch G, Sylvester R, Tangen C, Van Poppel H, Crawford ED (2004) Cytoreductive nephrectomy in patients with metastatic renal cancer: a combined analysis. J Urol 171(3):1071–1076. https://doi.org/10.1097/01.ju.0000110610.61545.ae - DOI - PubMed
    1. Bhindi B et al (2019) Systematic review of the role of cytoreductive nephrectomy in the targeted therapy era and beyond: an individualized approach to metastatic renal cell carcinoma. Eur Urol 75(1):111–128. https://doi.org/10.1016/j.eururo.2018.09.016 - DOI - PubMed
    1. Larcher A et al (2019) Individualised indications for cytoreductive nephrectomy: which criteria define the optimal candidates? Eur Urol Oncol 2(4):365–378. https://doi.org/10.1016/j.euo.2019.04.007 - DOI - PubMed
    1. Mejean A et al (2018) Sunitinib alone or after nephrectomy in metastatic renal-cell carcinoma. N Engl J Med 379(5):417–427. https://doi.org/10.1056/NEJMoa1803675 - DOI - PubMed
    1. Mejean A et al (2019) Cytoreductive nephrectomy (CN) in metastatic renal cancer (mRCC): update on carmena trial with focus on intermediate IMDC-risk population. J Clin Oncol 37(15 suppl):4508. https://doi.org/10.1200/JCO.2019.37.15_suppl.4508 - DOI

LinkOut - more resources