For certain patients with metastatic renal cell carcinoma (mRCC), metastasectomy (MTS) may help prolong survival, according to a systematic review published in Urologic Oncology: Seminars and Original Investigations.
The researchers queried EMBASE, PubMed, Cochrane Library, and Web of Science from inception through August 2020 for studies reporting outcomes of patients with mRCC who underwent MTS. They assessed the sites, times, amount, histology types of metastasis, and prior nephrectomy. The main efficacy endpoint was overall survival (OS). In a meta-analysis, hazard ratios (HRs), 95% confidence intervals (CIs), and I2 values were calculated. Every analysis group also had a forest plot.
Seventeen studies were eligible for the systematic review. Patients who did not undergo MTS, compared to those who did, had a poorer OS (HR, 2.15; 95% CI, 1.59-2.92; P<0.001). Among patients who received the most recently available target therapy without MTS, compared to patients with MTS, survival was also poorer (HR, 1.82; 95% CI, 1.23-2.70; P=0.003).
In the meta-analysis, HRs were higher for patients with non–lung-only metastasis (HR, 1.87; 95% CI, 1.55-2.26; P<0.001), synchronous metastasis (HR, 1.28; 95% CI, 1.10-1.49; P=0.001), and multiple metastases (HR, 2.06; 95% CI, 1.64-2.59; P<0.001). Factors associated with a better OS rate were clear cell–type mRCC (HR, 0.62; 95% CI, 0.48-0.82; P=0.0006) and prior nephrectomy (HR, 0.37; 95% CI, 0.15-0.91; P=0.03).
“MTS is a treatment option for mRCC patients with prolonged overall survival time. The operation has additional advantages, particularly in patients with lung only metastasis, asynchronous metastasis, fewer metastasis sites, clear cell–type metastatic RCC, and the patients who had received nephrectomy,” the researchers concluded.