Department of Urology.
Laboratory Medicine Center, The Second Hospital of Lanzhou University, Lanzhou, China.
Int J Surg. 2023 Oct 1;109(10):3178-3188. doi: 10.1097/JS9.0000000000000591.
This study aimed to conduct a pooled analysis to compare the outcomes of patients with metastatic renal cell carcinoma who received presurgical systemic therapy [(ST); including immunotherapy and/or targeted therapy] followed by cytoreductive nephrectomy (CN) [(deferred CN; (dCN)] with those who underwent upfront CN (uCN) followed by ST.
The present study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A comprehensive search was conducted in PubMed, Embase, Web of Science, Scopus, and the Cochrane Library database to identify eligible comparative studies up to April 2023. To evaluate their relevance, pooled hazard ratio with 95% CIs were calculated.
A total of 3157 patients were included in nine studies. The dCN group was observed to be correlated with superior overall survival (OS) compared to the uCN group (hazard ratio =0.71, 95% CI 0.57-0.89, P =0.003). Moreover, the authors conducted subgroup analyses according to the type of ST, sample size, sex, age, and risk score, and observed similar outcomes for OS across most subgroups.
The results of this study demonstrated that dCN may be associated with improved OS compared to uCN in patients with metastatic renal cell carcinoma receiving ST. However, no significant differences were found between the uCN and dCN groups in the immunotherapy-based combinations subgroup. Further research is needed to confirm these results.
本研究旨在进行荟萃分析，比较接受术前系统治疗[（ST）；包括免疫治疗和/或靶向治疗]后行细胞减灭性肾切除术（CN）[延迟 CN；（dCN）]与直接行 CN 后行 ST 的转移性肾细胞癌患者的结局。
本研究遵循系统评价和荟萃分析的首选报告项目（PRISMA）声明。对 PubMed、Embase、Web of Science、Scopus 和 Cochrane Library 数据库进行全面检索，以确定截至 2023 年 4 月的合格比较研究。为了评估其相关性，计算了合并危险比及其 95%置信区间。
共有 3157 名患者纳入了 9 项研究。与 uCN 组相比，dCN 组的总生存期（OS）显著延长（风险比=0.71，95%CI 0.57-0.89，P=0.003）。此外，作者根据 ST 类型、样本量、性别、年龄和风险评分进行了亚组分析，在大多数亚组中，OS 的结果相似。
这项研究的结果表明，与接受 ST 的转移性肾细胞癌患者直接行 CN 相比，dCN 可能与改善 OS 相关。然而，在基于免疫治疗的联合治疗亚组中，uCN 和 dCN 组之间未发现 OS 存在显著差异。需要进一步的研究来证实这些结果。
