Metastatic renal cancer: benefits of cytoreductive nephrectomy

  • Urol Oncol
  • 28 Mar 2019

  • curated by Deepa Koli
  • Univadis Clinical Summaries
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Takeaway

  • Tumor thrombus is common in patients with metastatic renal cell carcinoma (mRCC).
  • Cytoreductive nephrectomy (CN) is associated with improved OS in patients without thrombus, and those with tumor thrombus limited the renal vein and infradiaphragmatic inferior vena cava (IVC).
  • Patient and tumor characteristics influence the receipt of CN.

Why this matters

  • Findings suggest CN plays an important part of the multidisciplinary management of complex patients in the era of immunotherapy.

Study design

  • Study of 8134 patients with mRCC from National Cancer Database.
  • Funding: NIHHYB.

Key results

  • Of 28.7% patients with tumor thrombus, 78.2%, 16.5%, and 5.4% had tumor thrombus in renal vein, infradiaphragmatic IVC, and supradiaphragmatic IVC.
  • Black race, Medicaid or no insurance, unknown tumor size, and thrombus involving the supradiaphragmatic IVC were associated with significantly less likelihood of CN (all P<.01>
  • Patients with tumor thrombus were more likely to undergo a CN (P<.01 vs those without however rates of cn from to as thrombus level increased.>
  • CN was associated with improved OS in patients without thrombus (HR, 0.52; P<.01 with renal vein p or infradiaphragmatic thrombus>

Limitations

  • Retrospective design.

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