Petrelli Fausto, Coinu Andrea, Vavassori Ivano, Cabiddu Mary, Borgonovo Karen, Ghilardi Mara, Lonati Veronica, Barni Sandro
Medical Oncology Unit, ASST Bergamo Ovest, Treviglio, Italy.
Medical Oncology Unit, ASST Bergamo Ovest, Treviglio, Italy.
Clin Genitourin Cancer. 2016 Dec;14(6):465-472. doi: 10.1016/j.clgc.2016.04.001. Epub 2016 Apr 8.
Cytoreductive nephrectomy (CN) in metastatic renal cell carcinoma (mRCC) (resection of the primary tumor for debulking purposes) was considered to be an important part of oncological treatment when used with cytokines, and was associated with an overall survival (OS) benefit. However, the role of CN in the targeted therapy era is not well-defined. We conducted a systematic review and meta-analysis to determine the prognostic role of CN performed during the course of advanced disease in patients with mRCC treated with molecular agents. We searched PubMed, EMBASE, the Web of Science, Google Scholar, CINAHL, LILACS, the Cochrane Library, and SCOPUS for studies reporting survival data for participants who underwent CN with targeted therapy (CN+) versus those treated with targeted therapy alone (CN-). In a multivariate analysis, data were aggregated using hazard ratios with 95% confidence intervals for OS related to CN+. Twelve studies involving 39,953 patients were identified. In 11 publications with OS data available, the patients treated with CN+ had a reduced risk of death compared with those treated with targeted therapies alone (hazard ratio, 0.46; 95% confidence interval, 0.32-0.64; P < .01; I = 99%). Based on these results, CN+ reduces the risk of death in mRCC by more than 50% and should be discussed and included in the therapeutic armamentarium, as it still plays a therapeutic role, even in the post-cytokine era.
减瘤性肾切除术（CN）用于转移性肾细胞癌（mRCC）（为减瘤目的切除原发肿瘤），与细胞因子联合使用时被认为是肿瘤治疗的重要组成部分，且与总生存期（OS）获益相关。然而，在靶向治疗时代，CN的作用尚不明确。我们进行了一项系统评价和荟萃分析，以确定在接受分子靶向药物治疗的mRCC患者晚期疾病过程中进行CN的预后作用。我们检索了PubMed、EMBASE、科学网、谷歌学术、CINAHL、LILACS、考克兰图书馆和SCOPUS，查找报告接受靶向治疗联合CN（CN+）与单纯接受靶向治疗（CN-）参与者生存数据的研究。在多变量分析中，使用与CN+相关的OS的风险比及95%置信区间汇总数据。共纳入12项研究，涉及39953例患者。在11篇有OS数据的出版物中，与单纯接受靶向治疗的患者相比，接受CN+治疗的患者死亡风险降低（风险比，0.46；95%置信区间，0.32 - 0.64；P <.01；I² = 99%）。基于这些结果，CN+可使mRCC患者的死亡风险降低超过50%，应在治疗方案中进行讨论并纳入，因为即使在细胞因子治疗时代之后，它仍发挥着治疗作用。
