Azawi Nessn, Geertsen Louise, Nadler Naomi, Mosholt Karina Sif Soendergaard, Axelsen Sofie Staal, Christensen Jane, Jensen Niels Viggo, Fristrup Niels, Dalton Susanne Oksbjerg, Donskov Frede, Lund Lars
Department of Urology, Zealand University Hospital, Sygehusvej 10, 4000 Roskilde, Denmark.
Institute for Clinical Medicine, University of Copenhagen, Noerregade 10, 1165 Copenhagen, Denmark.
Cancers (Basel). 2024 Mar 12;16(6):1132. doi: 10.3390/cancers16061132.
(1) Background: The role of cytoreductive nephrectomy (CN) is controversial in patients with primary metastatic renal cell carcinoma (mRCC). (2) Methods: We evaluated the impact of CN, or no CN, followed by first-line targeted therapy (TT) in a nationwide unselected cohort of 437 consecutive patients with primary mRCC over a two-year period with a minimum of five years of follow-up. Data sources were national registries supplemented with manually extracted information from individual patient medical records. Cox proportional hazards estimated the hazard ratio (HR) of overall death and cancer-specific death after one and three years. (3) Results: 210 patients underwent CN and 227 did not. A total of 176 patients (40%) had CN followed by TT, 160 (37%) had TT alone, 34 (8%) underwent CN followed by observation, and 67 (15%) received no treatment. After adjustments in Model 2, patients treated with TT alone demonstrated a worsened overall survival (OS) compared to those treated with CN + TT, HR 0.63 (95% CI: 0.19-2.04). (4) Conclusions: In this nationwide study, CN was associated with enhanced outcomes in carefully selected patients with primary mRCC. Further randomized trials are warranted.
（1）背景：减瘤性肾切除术（CN）在原发性转移性肾细胞癌（mRCC）患者中的作用存在争议。（2）方法：我们评估了在一个全国性的、未经过选择的队列中，437例连续的原发性mRCC患者接受CN或不接受CN，随后进行一线靶向治疗（TT）的影响，该队列研究为期两年，随访时间至少为五年。数据来源是国家登记处，并辅以从个体患者病历中手动提取的信息。Cox比例风险模型估计了1年和3年后总体死亡和癌症特异性死亡的风险比（HR）。（3）结果：210例患者接受了CN，227例未接受。共有176例患者（40%）接受了CN后进行TT，160例（37%）仅接受TT，34例（8%）接受了CN后进行观察，67例（15%）未接受治疗。在模型2调整后，与接受CN + TT治疗的患者相比，仅接受TT治疗的患者总体生存率（OS）更差，HR为0.63（95%CI：0.19 - 2.04）。（4）结论：在这项全国性研究中，CN与精心选择的原发性mRCC患者的预后改善相关。有必要进行进一步的随机试验。
