Population-based Assessment of Survival After Cytoreductive Nephrectomy Versus No Surgery in Patients With Metastatic Renal Cell Carcinoma

Laurent Zinia, b, Umberto Capitanioa, c, Paul Perrotted, Claudio Jeldresa, Shahrokh F. Shariata, Philippe Arjaned, Hugues Widmerd, Francesco Montorsic, Jean-Jacques Patarde and Pierre I. Karakiewicza, d, ,

aCancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada

bDepartment of Urology, Lille University Hospital, Lille, France

cDepartment of Urology, Vita-Salute San Raffaele, Milan, Italy

dDepartment of Urology, University of Montreal, Montreal, Quebec, Canada

eDepartment of Urology, Rennes University Hospital, Rennes, France

Received 16 July 2008; accepted 9 September 2008. Available online 28 November 2008.
Objectives

To examine the population-based survival rates of patients with metastatic renal cell carcinoma (RCC) treated with cytoreductive nephrectomy (CNT) and compare them with those of patients treated without surgery.
Methods

Of the 43 143 patients with RCC identified in the 1988-2004 Surveillance, Epidemiology, and End Results database, 5372 had metastatic RCC. Of those, 2447 were treated with CNT (45.5%) and 2925 (54.5%) were not. Unvariable and multivariable Cox regression models, as well as matched and unmatched Kaplan-Meier survival analyses, were used. The covariates consisted of age, sex, tumor size, and year of diagnosis.
Results

The 1-, 2-, 5-, and 10-year overall survival rate of the patients treated with CNT was 53.6%, 36.3%, 19.4%, and 12.7% compared with 18.5%, 7.4%, 2.3%, and 1.2% for the no-surgery patients, respectively. The corresponding cancer-specific survival rates were 58.1%, 40.8%, 24.3%, and 18.8% and 24.4%, 11.0%, 4.1%, and 2.9% for the same patient groups. On multivariate analysis, independent predictor status was recorded for treatment type, tumor size, and patient age (all P <.001). Also, relative to CNT, the no-surgery group had a 2.5-fold greater rate of overall and cancer-specific mortality (P <.001). In the matched analyses, virtually the same effect was recorded (hazard ratio 2.6, P <.001).
Conclusion

The results of our study have shown that CNT significantly improves the survival of patients with metastatic RCC.