Metastasectomy without systemic therapy in metastatic renal cell carcinoma: comparison with conservative treatment

The objective of this study was to evaluate the efficacy of metastasectomy after nephrectomy in patients with metastatic renal cell carcinoma who had not received systemic therapy.

A total of 62 patients were included in the study. The patients were categorized according to their surgical treatment: the metastasectomy group (n = 21) and the nonmetastasectomy group (n = 41).

In the metastasectomy group, the median overall survival was 36.5 (range 4.0-182.7) months, whereas the patients of the nonmetastasectomy group reached a median overall survival of 8.4 (range 0.9-63.7) months (p < 0.001). The 1-, 3-, and 5-year overall survival rates were calculated at 71.4 and 34.1%, 47.6 and 9.8%, and 9.8 and 2.4%, respectively (p < 0.001). When the patients were stratified according to their characteristics, the overall survival was lower in the nonmetastasectomy group than in the metastasectomy group in the younger patients (p = 0.002), in both male (p = 0.001) and female (p = 0.030) patients, in patients with a poor performance status (p = 0.027), in patients with a shorter time between diagnosis of the primary tumor and development of metastases (p < 0.001), and in patients with a solitary metastasis (p = 0.005). Multivariate analysis using the Cox proportional hazards model showed that only the metastasectomy status was an independent predictor of the overall survival (Hazard ratio 2.57, 95% confidence interval 1.21-5.44; p = 0.014).

Our findings suggest that for the management of metastatic renal cell carcinoma, complete surgical resection of the metastatic lesions may prolong survival even in patients with some poor prognostic factors who cannot or are not willing to receive systemic therapy.