Cytoreductive Nephrectomy in Metastatic Renal Cell Carcinoma Treated With Targeted Therapies: A Systematic Review With a Meta-Analysis

Cytoreductive nephrectomy (CN) in metastatic renal cell carcinoma (mRCC) (resection of the primary tumor for debulking purposes) was considered to be an important part of oncological treatment when used with cytokines, and was associated with an overall survival (OS) benefit. However, the role of CN in the targeted therapy era is not well-defined. We conducted a systematic review and meta-analysis to determine the prognostic role of CN performed during the course of advanced disease in patients with mRCC treated with molecular agents. We searched PubMed, EMBASE, the Web of Science, Google Scholar, CINAHL, LILACS, the Cochrane Library, and SCOPUS for studies reporting survival data for participants who underwent CN with targeted therapy (CN+) versus those treated with targeted therapy alone (CN−). In a multivariate analysis, data were aggregated using hazard ratios with 95% confidence intervals for OS related to CN+. Twelve studies involving 39,953 patients were identified. In 11 publications with OS data available, the patients treated with CN+ had a reduced risk of death compared with those treated with targeted therapies alone (hazard ratio, 0.46; 95% confidence interval, 0.32-0.64; P < .01; I2 = 99%). Based on these results, CN+ reduces the risk of death in mRCC by more than 50% and should be discussed and included in the therapeutic armamentarium, as it still plays a therapeutic role, even in the post-cytokine era.