Department of Education, Taichung Veterans General Hospital, Taichung, Taiwan; School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan.
Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan; Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.
Urol Oncol. 2021 Jul;39(7):422-430. doi: 10.1016/j.urolonc.2021.02.026. Epub 2021 Apr 29.
Metastasectomy (MTS) is a treatment option for patients diagnosed with metastatic Renal Cell Carcinoma (mRCC). Nevertheless, the benefits of MTS as they pertain to survival remain controversial. This systematic review aims to compare the survival outcomes of patients who underwent MTS, as well as discover which clinical factors were related to the results.
From their inception up to August 2020, a systematic review of the EMBASE, PubMed, Cochrane library, and Web of science databases was performed. Studies which reported outcomes on patients who underwent MTS for the treatment of mRCC were included. The sites, times, amount, histology types of metastasis, and prior nephrectomy were also analyzed. The primary efficacy end point was Overall Survival (OS). A meta-analysis was performed to calculate hazard ratio, 95% confidence intervals, and I values. Forest plots were constructed for each analysis group.
The systematic review and reference list search identified 294 articles, with 17 meeting studies as inclusion criteria. The MTS group showed a competitive advantage in OS, in that the non-MTS group was negatively associated with an overall survival rate (HR [non-MTS vs. MTS] = 2.15, 95% CI: 1.59-2.92, P< 0.001). Moreover, patients treated with the most recently available target therapy without MTS showed a significantly increased risk compared with the MTS group (HR = 1.82, 95% CI:1.23-2.70, P= 0.003). Additionally, meta-analysis revealed HR elevating in patients with nonlung only metastasis (HR = 1.87, 95% CI: 1.55-2.26, P< 0.001), synchronous metastasis (HR = 1.28, 95% CI: 1.10-1.49, P= 0.001), and multiple metastases (HR = 2.06, 95% CI: 1.64-2.59, P< 0.001). Clear-cell type mRCC (HR = 0.62, 95% CI: 0.48-0.82, P= 0.0006) and prior nephrectomy (HR = 0.37, 95% CI: 0.15-0.91, P= 0.03) were positively associated with a better overall survival rate.
MTS is a treatment option for mRCC patients with prolonged overall survival time. The operation has additional advantages, particularly in patients with lung only metastasis, asynchronous metastasis, fewer metastasis sites, clear-cell type mRCC, and the patients who had received nephrectomy.
转移灶切除术（MTS）是治疗转移性肾细胞癌（mRCC）患者的一种治疗选择。然而，MTS 对生存的益处仍然存在争议。本系统评价旨在比较接受 MTS 治疗的患者的生存结果，并发现哪些临床因素与结果相关。
从成立到 2020 年 8 月，对 EMBASE、PubMed、Cochrane 图书馆和 Web of Science 数据库进行了系统评价。纳入了报告接受 MTS 治疗 mRCC 患者结局的研究。还分析了转移部位、时间、数量、组织学类型和先前的肾切除术。主要疗效终点是总生存期（OS）。进行了荟萃分析以计算风险比、95%置信区间和 I 值。为每个分析组构建了森林图。
系统评价和参考文献列表搜索共确定了 294 篇文章，其中 17 篇符合纳入标准。MTS 组在 OS 方面具有竞争优势，非 MTS 组与总体生存率呈负相关（HR[非 MTS 与 MTS] = 2.15，95%CI：1.59-2.92，P<0.001）。此外，未接受 MTS 治疗但最近接受了可用靶向治疗的患者与 MTS 组相比，风险显著增加（HR = 1.82，95%CI：1.23-2.70，P=0.003）。此外，荟萃分析显示，非肺转移（HR = 1.87，95%CI：1.55-2.26，P<0.001）、同步转移（HR = 1.28，95%CI：1.10-1.49，P=0.001）和多发性转移（HR = 2.06，95%CI：1.64-2.59，P<0.001）患者的 HR 升高。透明细胞型 mRCC（HR = 0.62，95%CI：0.48-0.82，P=0.0006）和先前肾切除术（HR = 0.37，95%CI：0.15-0.91，P=0.03）与总体生存率的提高呈正相关。
MTS 是 mRCC 患者的一种治疗选择，可延长总体生存时间。该手术具有额外的优势，特别是在仅有肺转移、不同步转移、转移部位较少、透明细胞型 mRCC 和接受过肾切除术的患者中。
