Cytoreductive nephrectomy in patients with metastatic non-clear-cell renal cell carcinoma (RCC)

Abstract

Objective: • To determine whether patients with metastatic non-clear-cell renal cell carcinoma (RCC) benefit from cytoreductive nephrectomy (CN). Patients and Methods: • We used the Surveillance, Epidemiology, and End Results (SEER) programme to identify a population-based sample of 4914 patients diagnosed with metastatic RCC between 2000 and 2009. • Of the 4914 patients, 591 had non-clear-cell histology. • The median follow-up was 20 months. • The primary outcome measure was RCC-specific mortality. Results: • Approximately 64% of patients underwent CN. • Patients with non-clear-cell histology who underwent CN had lower RCC-specific and all-cause mortality than those who did not (P < 0.001 in both cases). • After adjustment for age, gender, race, marital status, year of diagnosis, geographical location and histology, the associations between CN and lower RCC-specific mortality (hazard ratio [HR] 0.62, 95% confidence interval [CI] 0.48-0.80, P < 0.001) and between CN and all-cause mortality (HR 0.45, 95% CI 0.37-0.55, P < 0.001) remained highly significant. • Among patients diagnosed between 2006 and 2009 (targeted therapy era), the results remained unchanged (HR 0.50, 95% CI 0.34-0.72, P < 0.001 and HR 0.43, 95% CI 0.31-0.59, P < 0.001, respectively). • An interaction model found lower all-cause mortality for all histologies after CN. Conclusions: • Patients from the SEER programme with metastatic non-clear-cell RCC, including those treated in the targeted therapy era, appear to derive a survival benefit from CN, an association which remained significant regardless of histological subtype. • This observation suggests that CN should remain standard in patients with advanced RCC who are deemed to be surgical candidates. © 2013 The Authors.