Makrakis Dimitrios, Msaouel Pavlos, Karam Jose A, Esagian Stepan Μ
Department of Medicine, NYC Health + Hospitals / Jacobi, Albert Einstein College of Medicine, Bronx, NY, USA.
Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; David H. Koch Center for Applied Research of Genitourinary Cancers, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA.
Eur Urol Focus. 2025 Mar;11(2):356-364. doi: 10.1016/j.euf.2024.11.007. Epub 2024 Dec 12.
The role of cytoreductive nephrectomy (CN) in metastatic renal cell carcinoma (mRCC) in the era of immune checkpoint inhibitors (ICIs) is controversial. We aimed to investigate the survival benefit of CN in patients with mRCC treated with ICIs.
We searched the EMBASE, MEDLINE, and Web of Science databases up to August 26, 2023 to identify studies comparing overall survival (OS) for patients with mRCC treated with ICIs with or without CN. We reconstructed individual patient data using published Kaplan-Meier curves and performed one- and two-stage meta-analyses using 6-mo and 12-mo landmarks to control for immortal time bias. We also performed subgroup analyses for patients treated with first-line ICI or upfront CN.
We identified eight eligible studies involving a total of 2319 patients. There were statistically significant differences in baseline characteristics (age, clear cell histology, International mRCC Database Consortium scores) between the ICI + CN and ICI-alone groups. Combined CN + ICI therapy was associated with superior OS in the primary analysis (hazard ratio [HR] 0.45, 95% confidence interval [CI] 0.37-0.54) and secondary analyses, and in subgroup analyses for patients receiving first-line ICI therapy (HR 0.39, 95% CI 0.30-0.48) and upfront CN (HR 0.52, 95% CI 0.40-0.69).
CN combined with ICI therapy in mRCC may be associated with superior OS. Further studies are needed to confirm this finding and identify the patients most likely to benefit from CN in this setting.
We compared outcomes after immune checkpoint inhibitor (ICI) therapy, which boosts the immune system to fight cancer, with or without nephrectomy (surgical removal of the kidney) in patients with metastatic kidney cancer. We found that the combination of nephrectomy and ICI therapy was associated with better survival than just ICI therapy.
在免疫检查点抑制剂（ICI）时代，减瘤性肾切除术（CN）在转移性肾细胞癌（mRCC）中的作用存在争议。我们旨在研究CN对接受ICI治疗的mRCC患者的生存获益情况。
我们检索了截至2023年8月26日的EMBASE、MEDLINE和科学网数据库，以确定比较接受ICI治疗且有或无CN的mRCC患者总生存期（OS）的研究。我们利用已发表的Kaplan-Meier曲线重建个体患者数据，并使用6个月和12个月的时间节点进行单阶段和两阶段荟萃分析，以控制不朽时间偏倚。我们还对接受一线ICI或 upfront CN治疗的患者进行了亚组分析。
我们确定了八项符合条件的研究，共涉及2319名患者。ICI+CN组和单纯ICI组在基线特征（年龄、透明细胞组织学、国际mRCC数据库联盟评分）方面存在统计学显著差异。在初步分析、二次分析以及接受一线ICI治疗患者（风险比[HR] 0.39，95%置信区间[CI] 0.30-0.48）和 upfront CN患者（HR 0.52，95% CI 0.40-0.69）的亚组分析中，CN联合ICI治疗与更好的OS相关。
mRCC中CN联合ICI治疗可能与更好的OS相关。需要进一步研究来证实这一发现，并确定在此情况下最可能从CN中获益的患者。
我们比较了在转移性肾癌患者中，使用增强免疫系统抗癌的免疫检查点抑制剂（ICI）治疗，有或无肾切除术（手术切除肾脏）后的结果。我们发现肾切除术和ICI治疗相结合比单纯ICI治疗的生存期更好。
