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Review
. 2025 Apr;12(2):204-209.
doi: 10.1016/j.ajur.2024.06.003. Epub 2024 Aug 3.

The impact of deferred cytoreductive nephrectomy on survival in advanced renal cell carcinoma: A systematic review and meta-analysis

Mohammad Taufiq Alamsyah  1 , Fauriski Febrian Prapiska  2 , Syah Mirsya Warli  2
Affiliations
Review

The impact of deferred cytoreductive nephrectomy on survival in advanced renal cell carcinoma: A systematic review and meta-analysis

Mohammad Taufiq Alamsyah et al. Asian J Urol. 2025 Apr.

Abstract

Objective: Stage IV renal cell carcinoma (RCC) is associated with a significant decrease in survival rates. Cytoreductive nephrectomy (CN) is one of the treatments for stage IV RCC. However, there are studies showing that delayed CN might have benefits for the survival of the patients. We aimed to examine the impact of deferred CN on the survival of patients with advanced RCC in relation to sequential management with targeted therapy (TT).

Methods: A literature search was conducted in PubMed, EMBASE, EBSCOhost, MedRxiv, and Scopus. We included the randomized clinical trial and non-randomized study of intervention comparing the overall survival (OS) of upfront CN with deferred CN in patients with advanced RCC undergoing TT. Meta-analysis was carried out using Review Manager v5.4 software. The fixed-effect and random-effects models were used to obtain pooled estimates using the hazard ratio and standard error, presented using the forest plot with 95% confidence interval.

Results: Four studies were analyzed quantitatively. Our analysis revealed that patients with upfront TT followed by deferred CN had significantly improved OS compared to those who underwent upfront CN followed by TT (hazard ratio 0.50, 95% confidence interval 0.40-0.64, p<0.001).

Conclusion: The findings of the study suggest that considering upfront TT followed by deferred CN may lead to improved OS in patients with advanced RCC. However, more research is needed to fully understand the role, optimal timing, and sequencing of TT and CN in the treatment of advanced RCC.

Keywords: Advanced renal cell carcinoma; Cytoreductive nephrectomy; Deferred surgery; Overall survival.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Preferred Reporting Items for Systematic reviews and Meta-Analyses flow chart. RCC, renal cell carcinoma.
Figure 2
Figure 2
Fixed-effect modeled forest plot showing HR of overall survival in patients with deferred versus immediate CN. HR, hazard ratio; CN, cytoreductive nephrectomy; CI, confidence interval; SE, standard error; IV, inverse variance.
Figure 3
Figure 3
Random-effects modeled forest plot showing HR of overall survival in patients with deferred versus immediate CN. HR, hazard ratio; CN, cytoreductive nephrectomy; CI, confidence interval; SE, standard error; IV, inverse variance.
See this image and copyright information in PMC

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