Metastasectomy After Nephrectomy Provides No Benefit for Patients With sRCC

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Metastasectomy following nephrectomy provided no benefit for patients with renal cell carcinoma with sarcomatoid dedifferentiation.
Metastasectomy following nephrectomy provided no benefit for patients with renal cell carcinoma with sarcomatoid dedifferentiation.

Metastasectomy following nephrectomy provided no benefit for patients with renal cell carcinoma with sarcomatoid dedifferentiation (sRCC).1

Because management of sRCC has no standard treatment strategies, investigators sought to evaluate whether mestastasectomy provided survival benefit in patients treated with radical nephrectomy (RN).

Investigators matched 80 patients with synchronous and asynchronous metastasis for age, Eastern Cooperative Oncology Group performance status, histology, and lymph node status from an institutional database of 273 patients.

To reduce bias in survival outcomes, matched pairs were kept only if patients who did not undergo metastasectomy were comparably alive at the time of metastasectomy in matched surgical patients.

Results showed that for patients with synchronous metastases, median survival was 8.3 months (95% CI, 6.5 – 10.5 months) and 18.5 months (95% CI, 11.5 – 42.9 months) for patients with asynchronous metastases.   

Overall survival for those undergoing metastasectomy for synchronous metastasis compared to non-surgical patients was 8.4 and 8.0 months, respectively (P = .35). Overall survival for patients with asynchronous metastases undergoing metastasectomy compared to the non-surgical group was 36.2 and 13.7 months, respectively (P = .29).

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Multivariable analysis revealed that positive lymph node status at nephrectomy was linked with increased risk of death in both subgroups (HR = 2.1; 95% CI, 1.1 – 4.0; P = .03) and (HR = 3.3; 95% CI, 1.2 – 9.2; P = .02), respectively.

Reference

  1. Thomas AZ, Adibi M, Slack RS, et al. The role of metastasectomy in patients with renal cell carcinoma with sarcomatoid dedifferentiation: a matched controlled analysis [published online ahead of print March 29, 2016]. J Urol. doi: 10.1016/j.juro.2016.03.144.

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