Cytoreductive nephrectomy for synchronous metastatic renal cell carcinoma. Is there enough evidence?
Objective: To assess the role of Cytoreductive Nephrectomy for synchronous metastatic Renal Cell Carcinoma patients in the Systemic Therapy era and beyond regarding the Overall Survival, the optimal sequence between Systemic Therapy and Cytoreductive Nephrectomy and prognostic factors. Methods: Th...
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PAGEPress Publications
2022-12-01
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| Series: | Archivio Italiano di Urologia e Andrologia |
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| Online Access: | https://www.pagepressjournals.org/index.php/aiua/article/view/10838 |
| _version_ | 1797975365513117696 |
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| author | Stamatios Katsimperis Lazaros Tzelves Themistoklis Bellos Konstantinos Pikramenos Ioannis Manolitsis Ioannis Tsikopoulos Iraklis Mitsogiannis |
| author_facet | Stamatios Katsimperis Lazaros Tzelves Themistoklis Bellos Konstantinos Pikramenos Ioannis Manolitsis Ioannis Tsikopoulos Iraklis Mitsogiannis |
| author_sort | Stamatios Katsimperis |
| collection | DOAJ |
| description |
Objective: To assess the role of Cytoreductive Nephrectomy for synchronous metastatic Renal Cell Carcinoma patients in the Systemic Therapy era and beyond regarding the Overall Survival, the optimal sequence between Systemic Therapy and Cytoreductive Nephrectomy and prognostic factors.
Methods: The systematic review was conducted in accordance with the PRISMA guidelines. Bibliographic search was performed in Medline (PubMed), ClinicalTrials.gov, and Cochrane Library-Cochrane Central Register of Controlled Trials (CENTRAL). Studies included were those indexed from 2005 in an attempt to limit those conducted in the cytokine era. Risk of bias assessment was performed by two authors (K.S and T.L) using the Cochrane Collaborative Risk of Bias tool for randomized trials, the Cochrane Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool for nonrandomized studies.
Results: Cytoreductive nephrectomy was associated with improved overall survival in all but one of the observational studies. While in all of these studies the unvariable analysis showed improved overall survival in favor of the cytoreductive nephrectomy group in some studies the subgroup analysis showed no benefit. Regarding the optimal sequence, deferred cytoreductive nephrectomy demonstrated better results in more studies than upfront cytoreductive nephrectomy but a advantage was not clearly certain. In the analysis of possible prognostic factors for overall survival with cytoreductive nephrectomy, most common prognostic factors found were age (in 8 studies), tumor histology (in 7 studies), number of metastasis (in 6 studies), and T stage.
Conclusions: Cytoreductive nephrectomy can still play an important role in wisely selected patients, although the role of cytoreductive nephrectomy in the new immunotherapy era needs to be defined.
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| first_indexed | 2024-04-11T04:34:24Z |
| format | Article |
| id | doaj.art-1af497dda7df4d47969a4791bd6cc757 |
| institution | Directory Open Access Journal |
| issn | 1124-3562 2282-4197 |
| language | English |
| last_indexed | 2024-04-11T04:34:24Z |
| publishDate | 2022-12-01 |
| publisher | PAGEPress Publications |
| record_format | Article |
| series | Archivio Italiano di Urologia e Andrologia |
| spelling | doaj.art-1af497dda7df4d47969a4791bd6cc7572022-12-28T22:38:38ZengPAGEPress PublicationsArchivio Italiano di Urologia e Andrologia1124-35622282-41972022-12-0194410.4081/aiua.2022.4.476Cytoreductive nephrectomy for synchronous metastatic renal cell carcinoma. Is there enough evidence?Stamatios Katsimperis0Lazaros Tzelves1Themistoklis Bellos2Konstantinos Pikramenos3Ioannis Manolitsis4Ioannis Tsikopoulos5Iraklis Mitsogiannis6Department of Urology, Athens Department of Urology, AthensDepartment of Urology, AthensDepartment of Urology, AthensDepartment of Urology, AthensDepartment of Urology, AthensDepartment of Urology, Athens Objective: To assess the role of Cytoreductive Nephrectomy for synchronous metastatic Renal Cell Carcinoma patients in the Systemic Therapy era and beyond regarding the Overall Survival, the optimal sequence between Systemic Therapy and Cytoreductive Nephrectomy and prognostic factors. Methods: The systematic review was conducted in accordance with the PRISMA guidelines. Bibliographic search was performed in Medline (PubMed), ClinicalTrials.gov, and Cochrane Library-Cochrane Central Register of Controlled Trials (CENTRAL). Studies included were those indexed from 2005 in an attempt to limit those conducted in the cytokine era. Risk of bias assessment was performed by two authors (K.S and T.L) using the Cochrane Collaborative Risk of Bias tool for randomized trials, the Cochrane Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool for nonrandomized studies. Results: Cytoreductive nephrectomy was associated with improved overall survival in all but one of the observational studies. While in all of these studies the unvariable analysis showed improved overall survival in favor of the cytoreductive nephrectomy group in some studies the subgroup analysis showed no benefit. Regarding the optimal sequence, deferred cytoreductive nephrectomy demonstrated better results in more studies than upfront cytoreductive nephrectomy but a advantage was not clearly certain. In the analysis of possible prognostic factors for overall survival with cytoreductive nephrectomy, most common prognostic factors found were age (in 8 studies), tumor histology (in 7 studies), number of metastasis (in 6 studies), and T stage. Conclusions: Cytoreductive nephrectomy can still play an important role in wisely selected patients, although the role of cytoreductive nephrectomy in the new immunotherapy era needs to be defined. https://www.pagepressjournals.org/index.php/aiua/article/view/10838cytoreductive nephrectomymetastatic renal cell carcinomasystematic therapyImmune check point inhibitors |
| spellingShingle | Stamatios Katsimperis Lazaros Tzelves Themistoklis Bellos Konstantinos Pikramenos Ioannis Manolitsis Ioannis Tsikopoulos Iraklis Mitsogiannis Cytoreductive nephrectomy for synchronous metastatic renal cell carcinoma. Is there enough evidence? Archivio Italiano di Urologia e Andrologia cytoreductive nephrectomy metastatic renal cell carcinoma systematic therapy Immune check point inhibitors |
| title | Cytoreductive nephrectomy for synchronous metastatic renal cell carcinoma. Is there enough evidence? |
| title_full | Cytoreductive nephrectomy for synchronous metastatic renal cell carcinoma. Is there enough evidence? |
| title_fullStr | Cytoreductive nephrectomy for synchronous metastatic renal cell carcinoma. Is there enough evidence? |
| title_full_unstemmed | Cytoreductive nephrectomy for synchronous metastatic renal cell carcinoma. Is there enough evidence? |
| title_short | Cytoreductive nephrectomy for synchronous metastatic renal cell carcinoma. Is there enough evidence? |
| title_sort | cytoreductive nephrectomy for synchronous metastatic renal cell carcinoma is there enough evidence |
| topic | cytoreductive nephrectomy metastatic renal cell carcinoma systematic therapy Immune check point inhibitors |
| url | https://www.pagepressjournals.org/index.php/aiua/article/view/10838 |
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