Utility of cytoreductive nephrectomy in targeted therapy era retrospective analysis

Jaiprakash Gurawalia; Syed Altaf; Kapil Dev; Swamyvelu Krishnamurthy; Sandeep Nayak P; Shiva Kumar

Volume : VI, Issue : III, March - 2017

Utility of cytoreductive nephrectomy in targeted therapy era retrospective analysis

Jaiprakash Gurawalia, Syed Altaf, Kapil Dev, Swamyvelu Krishnamurthy, Sandeep Nayak P, Shiva Kumar

Abstract :

Background: Metastatic RCC(mRCC) patients have poor prognosis with a 2–year survival of 10–20%. Prior trials of targeted agents for the treatment of mRCC had most of the patients undergone prior nephrectomy, hence the benefits of such agents can be recognised within the context of a resected primary only. Objective: To analyse the additional benefit of cytoreductive nephrectomy to tyrosine kinase inhibitors(TKIs) in mRCC. Design, setting, and participants: This is a single institutional retrospective study performed to address the survival benefit of CN in mRCC patients treated with targeted therapy over a period 2007 to 2014. All mRCC were categorised in two groups, First, patients received TKI after CN and Second, only TKI. Outcome measurements and statistical analysis: Relationships with outcome analysed using Kaplan–Meier methods and log–rank analysis. Results and limitations: We analysed 189 patients in our study, out of which 71 received only TKI therapy with a median follow up of 26.2 months. CN was done in 118 patients out of which 112 also received TKI therapy. Six –month PFS was 21% in TKI and 65% in CN group(p=0.0001). At the end of one year, all the patients TKI had progression while PFS in CN was 16.9%(p=0.0001). The median OS for CN patients was 16.4 months( 95% CI, 7.2–34) versus 7.8 months(95% CI, 3.8–22.2) in TKI group(p=0.03). Limitations of this study were retrospective analysis, patient selection bias regarding performance status. Conclusions: We concluded CN may provide an OS and PFS benefit in mRCC patients treated with targeted therapy.