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Role of Cytoreductive Nephrectomy in the Immune Checkpoint Inhibitor Era: A Multicenter Collaborative Study.
Takuhisa Nukaya1, Kiyoshi Takahara1, Shingo Toyoda2
1Department of Urology, Fujita-Health University School of Medicine, Toyoake, Japan.
Summary
Cytoreductive nephrectomy (CN) significantly improves overall survival (OS) for metastatic renal cell carcinoma (mRCC) patients on immune checkpoint inhibitor (ICI) therapy. A prognostic model aids in selecting appropriate candidates for CN.
Area of Science:
- Oncology
- Nephrology
- Immunotherapy
Background:
- Metastatic renal cell carcinoma (mRCC) presents complex treatment challenges.
- Immune checkpoint inhibitor (ICI) therapy has revolutionized mRCC treatment.
- The role of cytoreductive nephrectomy (CN) in the ICI era requires further clarification.
Purpose of the Study:
- To evaluate overall survival (OS) in mRCC patients receiving ICI-based therapy.
- To determine the optimal timing for cytoreductive nephrectomy (CN) in this patient population.
Main Methods:
- Retrospective analysis of 447 mRCC patients treated with ICI across Japanese institutions (2018-2023).
- Comparison of 72 patients undergoing CN versus 106 patients receiving ICI therapy alone (non-CN group).
- Inclusion of patients with lymph node or distant metastases.
Main Results:
- Median progression-free survival: 15.7 months; median OS: 58.1 months.
- CN significantly improved OS (not reached) compared to the non-CN group (29.6 months, p=0.01).
- Deferred CN also demonstrated improved survival; poor prognostic factors for immediate CN identified.
Conclusions:
- Cytoreductive nephrectomy (CN) is associated with improved survival outcomes in mRCC patients treated with ICI.
- A prognostic model was developed to guide patient selection for CN.
- Personalized treatment strategies are crucial for optimizing outcomes in mRCC.
Keywords:
IMDC classificationcytoreductive nephrectomyimmune checkpoint inhibitorneutrophil‐to‐lymphocyte ratiosarcomatoid differentiationMore Related Videos
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