open access publication

Article, 2024

Cytoreductive Nephrectomy in Select Primary Metastatic Renal Cell Carcinoma Patients: A Comprehensive Nationwide Outcome Analysis

Cancers, ISSN 2072-6694, Volume 16, 6, Page 1132, 10.3390/cancers16061132

Contributors

Azawi, Nessn Htum Majeed 0000-0001-7519-8654 (Corresponding author) [1] [2] Geertsen, Louise 0000-0003-0391-0205 [3] [4] Nadler, Naomi 0000-0002-1416-2153 [1] Mosholt, Karina Sif Soendergaard [5] Axelsen, Sofie Staal [6] Christensen, Jane Hvarregaard 0000-0002-0009-2991 [7] Jensen, Niels Viggo [4] Fristrup, Niels 0009-0006-4442-0535 [6] Dalton, Susanne Oksbjerg 0000-0002-5485-2730 [2] [7] [8] Donskov, Frede N 0000-0002-8449-863X [4] Lund, Lars H 0000-0003-0391-9568 [3] [4]

Affiliations

  1. [1] Zealand University Hospital Roskilde
    2. [NORA names: Region Zealand; Hospital; Denmark; Europe, EU; Nordic; OECD];
  2. [2] University of Copenhagen
    3. [NORA names: KU University of Copenhagen; University; Denmark; Europe, EU; Nordic; OECD];
  3. [3] University of Southern Denmark
    4. [NORA names: SDU University of Southern Denmark; University; Denmark; Europe, EU; Nordic; OECD];
  4. [4] Odense University Hospital
    5. [NORA names: Region of Southern Denmark; Hospital; Denmark; Europe, EU; Nordic; OECD];
  5. [5] Department of Urology, Rigs Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark;, karina.sif.soendergaard.mosholt@regionh.dk
    6. [NORA names: Denmark; Europe, EU; Nordic; OECD];

Abstract

(1) Background: The role of cytoreductive nephrectomy (CN) is controversial in patients with primary metastatic renal cell carcinoma (mRCC). (2) Methods: We evaluated the impact of CN, or no CN, followed by first-line targeted therapy (TT) in a nationwide unselected cohort of 437 consecutive patients with primary mRCC over a two-year period with a minimum of five years of follow-up. Data sources were national registries supplemented with manually extracted information from individual patient medical records. Cox proportional hazards estimated the hazard ratio (HR) of overall death and cancer-specific death after one and three years. (3) Results: 210 patients underwent CN and 227 did not. A total of 176 patients (40%) had CN followed by TT, 160 (37%) had TT alone, 34 (8%) underwent CN followed by observation, and 67 (15%) received no treatment. After adjustments in Model 2, patients treated with TT alone demonstrated a worsened overall survival (OS) compared to those treated with CN + TT, HR 0.63 (95% CI: 0.19-2.04). (4) Conclusions: In this nationwide study, CN was associated with enhanced outcomes in carefully selected patients with primary mRCC. Further randomized trials are warranted.

Keywords

Cox, Cox proportional hazards, TT, adjustment, analysis, associated with enhanced outcomes, cancer-specific death, carcinoma, carcinoma patients, cell carcinoma, cell carcinoma patients, cohort, comprehension, consecutive patients, cytoreductive nephrectomy, data, data sources, death, first-line targeted therapy, follow-up, hazard, hazard ratio, impact, impact of CN, individual patient medical records, information, medical records, metastatic renal cell carcinoma, metastatic renal cell carcinoma patients, minimum, model, model 2, national registry, nephrectomy, no treatment, observations, outcome analysis, outcomes, overall death, overall survival, patients, patients treated with TT, patients' medical records, period, primary metastatic renal cell carcinoma, proportional hazards, randomized trials, ratio, records, registry, renal cell carcinoma, renal cell carcinoma patients, source, survival, therapy, treated with CN, treatment, trials, two-year period, worsened overall survival, years, years of follow-up

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