Cytoreductive Nephrectomy beneficial in metastatic renal cell carcinoma: Study

Renal cancer is one of the most frequently diagnosed solid malignancies, and in almost one out of five patients, the disease is metastatic at presentation. The 2019 update of the European Association of Urology guidelines on renal cell carcinoma, advises against immediate cytoreductive nephrectomy (CN) in favor of systemic therapy for patients with metastatic renal cell carcinoma (mRCC) and asymptomatic presentation. The role of cytoreductive nephrectomy (CN) patients with metastatic renal cell carcinoma (mRCC) are unclear to date.

With this in mind, Alessandro Larcher et al undertook a study to define the proportion of symptomatic mRCC, to investigate the impact of CN on symptomatic improvement and perioperative morbidity, and to elucidate the trade-off between such benefit and harm.

An observational study of 317 mRCC patients treated with CN was performed. Symptomatic mRCC was defined as the presence of any sign or symptom causally related to the disease. Sign or symptom resolution and improvement were defined as the absence of all the signs and symptoms recorded at baseline, and the absence of at least one sign or symptom recorded at baseline, respectively.

The following facts were revealed in data analysis.

• Response to CN was classified as beneficial, mixed, or harmful according to the trade-off between symptomatic improvement and perioperative morbidity.
• The proportions of local, metastasis specific, and general signs or symptoms were 37%, 23%, and 27%, respectively.
• The proportions of any sign or symptom resolution and improvement after CN were 43% and 71%, respectively.
• The proportions of local sign or symptom resolution and improvement after CN were 91% and 95%, respectively.
• The risks of any complication and major complications were 37% and 10%, respectively. At regression analysis, symptomatic status was not associated with perioperative morbidity.

Current clinical decision making concerning surgical indication in patients with symptomatic mRCC is not a simple task.

This report highlights that the decision in favor of CN might yield potential benefits, such as superior quality of life due to symptom improvement or resolution and longer survival in selected candidates.

"In conclusion, symptomatic mRCC presentation at diagnosis is more common than asymptomatic presentation: two out of three patients suffer from any sign or symptom, and one out of three patients suffers from local signs or symptoms only. The study supports clinical decision making with the evidence that the indication for CN has a positive impact on the symptomatic status and that such beneficial response is maximal in patients with local signs and symptoms only. Further research and specific recommendations for symptomatic mRCC cases are required in the context of guideline-based management." wrote the team.

Primary source: European Urology

For full article,click the link : 10.1016/j.eururo.2020.05.014