Clinical outcomes of deferred cytoreductive nephrectomy after initial systemic therapy in metastatic renal cell carcinoma: A multicenter retrospective study
Por:
Rioja, P, Passarella, C, Angel, M, Valderrama, W, Ainaud, FB, Anguera, G, Gómez, V, Ruiz-Granados, A, Plata, D, Zapata, MI, Orta-Ruiz, A, Quiroga, MNG, Bourlon, MT, Grande, E, Kopp, RM, Molina-Cerrillo, J, Maroto, P, Sade, JP, Castellano, D
Publicada:
1 jul 2026
Ahead of Print:
1 may 2026
Resumen:
Introduction: Deferred cytoreductive nephrectomy (dCN) is a selective strategy for managing metastatic renal cell carcinoma (mRCC), in the era of immune checkpoint inhibitors (ICI) and tyrosine kinase inhibitors (TKI), particularly for patients who achieve favorable responses to initial systemic therapy. This study aims to describe the clinical outcomes of dCN following first-line systemic treatment within a sequential management approach. Methods: This multi-institutional retrospective study included 50 patients with clear cell mRCC who underwent dCN after first-line therapy. Patients were categorized according to treatment regimen (TKI monotherapy or ICI-based combinations). Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method. Prognostic factors were evaluated with Cox proportional hazards regression. A P-value < 0.05 was considered statistically significant. Results: Median follow-up was 19 months (range 1-174 months). First-line therapy included ICI + ICI in 24%, ICI + TKI in 46%, and TKI alone in 30% of patients. The overall response rate was 64%, and the disease control rate was 84%. Median time from systemic therapy initiation to cytoreductive nephrectomy was 5.6 months. Median PFS was 36 months, 12-, 36-, and 60-month PFS rates of 77%, 49%, and 40%, respectively. Longer PFS occurred in patients with a Karnofsky performance status (KPS) >80% (51 vs. 14 months; P = 0.037) and complete response (P = 0.0021). Median OS reached 91 months. Limitations included a retrospective design and a modest sample size. Conclusions: dCN may offer durable benefit in well-selected patients achieving disease control and good performance status after systemic therapy. The optimal timing remains uncertain and warrants validation in larger prospective trials. (c) 2026 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.
Filiaciones:
Rioja, P:
Inst Nacl Enfermedades Neoplas, Dept Med Oncol, Lima, Peru
Univ San Ignacio Loyola USIL, Lima, Peru
Passarella, C:
Hosp Univ Austral, Dept Med Oncol, Buenos Aires, Argentina
Angel, M:
Inst Alexander Fleming, Dept Med Oncol, Buenos Aires, Argentina
Valderrama, W:
Hosp Univ Austral, Dept Med Oncol, Buenos Aires, Argentina
Ainaud, FB:
Hosp Santa Creu & Sant Pau, Dept Med Oncol, Barcelona, Spain
Anguera, G:
Hosp Santa Creu & Sant Pau, Dept Med Oncol, Barcelona, Spain
Gómez, V:
Hosp Univ Ramon Y Cajal, Dept Med Oncol, Madrid, Spain
Ruiz-Granados, A:
Hosp Univ Ramon Y Cajal, Dept Med Oncol, Madrid, Spain
Plata, D:
Soc Oncol & Hematol Cesar, Dept Med Oncol, Valledupar, Colombia
Zapata, MI:
Inst Nacl cancerol, Dept Med Oncol, Bogota, Colombia
Orta-Ruiz, A:
Inst Nacl cancerol, Dept Med Oncol, Bogota, Colombia
MD Anderson Canc Ctr Madrid, Dept Med Oncologist, Madrid, Spain
Quiroga, MNG:
Inst Oncol Angel H Roffo, Dept Med Oncol, Buenos Aires, Argentina
Bourlon, MT:
Inst Nacl Ciencias Med Nutr Salvador Zubiran, Dept Med Oncol, Mexico City, Mexico
Grande, E:
MD Anderson Canc Ctr Madrid, Dept Med Oncologist, Madrid, Spain
Kopp, RM:
Soc Oncol & Hematol Cesar, Dept Med Oncol, Valledupar, Colombia
Molina-Cerrillo, J:
Hosp Univ Ramon Y Cajal, Dept Med Oncol, Madrid, Spain
Maroto, P:
Hosp Santa Creu & Sant Pau, Dept Med Oncol, Barcelona, Spain
Sade, JP:
Inst Alexander Fleming, Dept Med Oncol, Buenos Aires, Argentina
Castellano, D:
Hosp Univ 12 Octubre, Dept Med Oncol, Madrid, Spain
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