Cytoreductive partial nephrectomy versus cytoreductive nephrectomy in metastatic renal cell carcinoma

Introduction. Cytoreductive nephrectomy (CN) remains the standard of care in multimodal treatment for metastatic renal cell carcinoma (mRCC) with favorable prognosis. Cytoreductive partial nephrectomy (CPN), however, is infrequently performed in mRCC.

Objective. To compare the effectiveness of CPN versus CN in real-world clinical practice.

Materials & methods. This retrospective study included 102 patients with mRCC, comprising 32 who underwent CPN and 70 who underwent CN. Disease outcomes encompassed all-cause mortality, 30-day mortality, and 90-day mortality, stratified by cytoreductive surgery type (CPN vs CN). Clinical data were retrospectively retrieved and analyzed from medical records, with all patients undergoing comprehensive clinical-laboratory and histopathological evaluation. The primary endpoint was overall survival (OS) in patients undergoing CPN or CN. Secondary outcomes included length of hospital stay and readmission rates. Survival metrics were assessed using survival analysis, including life tables and Kaplan-Meier curves.

Results. Compared to the CN group, patients undergoing CPN less frequently had clear cell RCC (84.4% vs 97.1%), poorly differentiated tumors (21.9% vs 41.4%), synchronous metastases (21.9% vs 40.0%), and multiple metastases (59.4% vs 78.6%). Clinical T1 stage was significantly more common in the CPN group (84.4% vs 15.8%). CPN patients more often belonged to the favorable IMDC prognostic group (34.4% vs 25.7%). Lung metastases (53.1% vs 80.0%) and lymph node involvement (6.2% vs 22.8%) were less frequent in the CPN cohort, as were checkpoint inhibitor therapies (3.1% vs 18.6%) and radiotherapy (6.2% vs 18.6%). Three- and five-year OS rates were 62.9% and 40.5% for CPN versus 68.1% and 56.3% for CN, respectively (p = 0.08).

Conclusions. Optimal indications for cytoreductive partial nephrectomy in mRCC remain undefined. Despite more favorable baseline characteristics in the CPN cohort, overall survival favored the CN group. Further research is needed to identify patients most suitable for this palliative approach, aiming to refine personalized treatment strategies and improve survival outcomes.

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