(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.
Cancers. 2024 Mar 12*** epublish ***
Nessn Azawi, Louise Geertsen, Naomi Nadler, Karina Sif Soendergaard Mosholt, Sofie Staal Axelsen, Jane Christensen, Niels Viggo Jensen, Niels Fristrup, Susanne Oksbjerg Dalton, Frede Donskov, Lars Lund
Department of Urology, Zealand University Hospital, Sygehusvej 10, 4000 Roskilde, Denmark., Department of Urology, Odense University Hospital, J. B. Winslows Vej 4, 5000 Odense, Denmark., Department of Urology, Rigs Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark., Department of Oncology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 161, 8200 Aarhus, Denmark., Danish Cancer Society, Strandboulevarden 49, 2100 Copenhagen, Denmark., Department of Oncology, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense, Denmark., Institute for Clinical Medicine, University of Copenhagen, Noerregade 10, 1165 Copenhagen, Denmark., Department of Oncology, Southern Denmark University Hospital, Esbjerg, Finsensgade 35, 6700 Esbjerg, Denmark.