Metastatic renal cell carcinoma patients of T4 stage who are in status of N1 stage or older than 76 years cannot benefit from cytoreductive nephrectomy

Abstract

Background: We aimed to identify which part of the patients with metastatic renal cell carcinoma (mRCC) is not suitable for cytoreductive nephrectomy (CN). Methods: The data of mRCC patients was acquired from the Surveillance, Epidemiology, and End Results (SEER) database. Multivariate cox regression analysis and nomogram were performed for selecting factors independently associated with survival. Propensity score matching (PSM) was applied to reduce potential bias when comparing survival of mRCC patients treated by CN or non-surgery (NS). The survival analysis of subgroups was estimated by the Kaplan-Meier method and compared by log-rank testing. The summary of subgroup analysis was showed by forest plots. Results: The records of 21,411 patients with mRCC were obtained from the SEER database. After screening, a total of 6532 patients were included for further analysis, of which 6043 underwent CN and 489 underwent NS. Age, T stage, N stage and tumor size were involved in subgroup analysis by PSM according to the result of multivariate cox regression analysis and clinical experience. Survival benefit was not found in T4 stage patients. Further analysis showed that T4&N1 and T4&age ≥ 76 yr subgroups could not obtain survival benefit from CN. Conclusion: CN should not be performed in T4 stage mRCC patients who were in status of N1 stage or older than 76 years, because surgery cannot take significant survival benefit for them.

Sigmoid colon metastasis after radical nephrectomy for clear cell renal carcinoma: a case report and literature review

“…Surgery is not always a viable option for patients with mRCC. For example, T4 stage mRCC patients who were in the status of N1 stage or older than 76 years, there is no difference in overall survival between cytoreductive nephrectomy and non-surgical treatment [37].…”

Cytoreductive Nephrectomy and Metastatic Renal Cell Carcinoma: State of the Art and Future Perspectives

“…In particular, pathological Grade 4 was associated with a bad prognosis, and the presence of a major organ metastasis (bone, brain, liver and lung) improved survival time. Zahng et al also showed that, in 6043 patients with mRCC, CN was not suggested as the first-line strategy in T4 patients; in particular, T4 stage, N1 and age ≥ 76 yr were important risk factors influencing CSS [48]. Faba et al reported that CN showed several benefits in young male patients with oligometastatic disease and a good performance status, while patients whose life expectancy was short, who had poor risk-IMDC (International Metastatic RCC Database Consortium), or with liver and/or bone metastases, and positive lymph nodes, in addition to sarcomatoid components, showed no benefits from CN [49].…”