Cytoreductive nephrectomy and its effect on prognosis in patients with disseminated renal cell carcinoma receiving treatment in wide clinical practice

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Abstract

Aim. To evaluate the effect of cytoreductive nephrectomy (CN) on overall survival (OS) in patients with metastatic renal cell carcinoma (mRCC) and to identify a group of patients who are candidates for cytoreductive surgical treatment.

Materials and methods. We retrospectively analyzed a database of 403 patients with mRCC treated at the Moscow City Oncological Hospital No. 62 and the City Clinical Oncological Dispensary (Saint Petersburg) between 2006 and 2022. In total, 330 (81.9 %) patients underwent CN. All patients received systemic anti-tumor therapy: targeted anti-angiogenic therapy - 317 (78.6 %), cytokines - 61 (15.1 %), checkpoint inhibitors - 25 (6.2 %). The groups of operated and non-operated patients were unbalanced: CN was more often not performed in patients with multiple metastases, bone and liver lesions, laboratory abnormalities (anemia, increased serum alkaline phosphatase and lactate dehydrogenase) and unfavorable prognosis per IMDC (International mRCC Database Consortium) classification (p >0.05 for all). 

Results. CN was associated with a significant increase in OS compared with primary tumor preservation in situ: median OS was 36 months with 95 % confidence interval 29.1-37.1, and 11 months with 95 % confidence interval 8.1-21.3, respectively (p <0.0001). The benefit for OS in the CN group was also observed in clear-cell mRCC (p <0.0001), grade G3 (p <0.0001), multiple metastases (p <0.0001) groups, and in the IMDC poor prognosis group (p <0.0001). 

Conclusion. CN in selected mRCC patients results in a significant increase in OS. Further research is needed to determine selection criteria for surgical treatment candidates. 

About the authors

D. V. Semenov

Saint Petersburg State University; City Clinical Oncological Dispensary

Author for correspondence.
Email: sema.69@mail.ru
ORCID iD: 0000-0002-4335-8446

Dmitriy V. Semenov.

7-9 Universitetskaya Naberezhnaya, Saint Petersburg 199034; 56 Veteranov Prospekt, Saint Petersburg 198255

Russian Federation

R. V. Orlova

Saint Petersburg State University; City Clinical Oncological Dispensary

ORCID iD: 0000-0002-9368-5517

7-9 Universitetskaya Naberezhnaya, Saint Petersburg 199034; 56 Veteranov Prospekt, Saint Petersburg 198255

Russian Federation

V. I. Shirokorad

Moscow City Oncology Hospital No. 62, Moscow Healthcare Department

ORCID iD: 0000-0003-4109-6451

27 Istra, Moscow Region 143515

Russian Federation

S. V. Kostritskiy

Moscow City Oncology Hospital No. 62, Moscow Healthcare Department

ORCID iD: 0000-0003-4494-1489

27 Istra, Moscow Region 143515

Russian Federation

M. I. Gluzman

Saint Petersburg State University; City Clinical Oncological Dispensary

ORCID iD: 0000-0002-8965-8364

7-9 Universitetskaya Naberezhnaya, Saint Petersburg 199034; 56 Veteranov Prospekt, Saint Petersburg 198255

Russian Federation

Yu. S. Korneva

City Hospital No. 26; Smolensk State Medical University, Ministry of Health of Russia; I.I. Mechnikov North-West State Medical University, Ministry of Health of Russia

ORCID iD: 0000-0002-8080-904X

Department of Pathological Anatomy, Smolensk State Medical University, Ministry of Health of Russia.

2 Kostyushko St., Saint Petersburg 196247; 28 Krupskoy St., Smolensk 214019; 41 Kirochnaya St., Saint Petersburg 191015

Russian Federation

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