Complete Metastasectomy for Metastatic RCC Linked With Improved Survival

Undergoing complete metastasectomy for metastatic renal cell carcinoma (RCC) was associated with improved survival outcomes, according to the results of a meta-analysis published in the Journal of Urology.

“While these studies were all observational with low-moderate risk of bias, there was consistency in the benefit across studies, with a pooled hazard ratio [HR] of 2.37,” wrote Harras B. Zaid, of the department of urology at the Mayo Clinic in Rochester, Minnesota, and colleagues. “Consideration should be given to perform complete metastasectomy in patients with metastatic RCC who are surgical candidates with potentially resectable disease.”

Data on the role of complete metastasectomy in patients with metastatic RCC are limited to observational studies and case series.

“Despite the low certainty in the evidence, National Comprehensive Cancer Network guidelines for patients presenting with metastatic RCC recommend nephrectomy and metastasectomy of solitary metastatic lesions,” the researchers wrote. “Furthermore, for patients who have relapsed after initial curative surgery, these same guidelines call for systemic therapy, with possible metastasectomy as a ‘best supportive care’ adjunct.”

With this review and meta-analysis, the researchers looked at comparative studies with adjusted HRs for all-cause mortality to compare survival outcomes in patients with metastatic RCC who have undergone complete vs incomplete metastasectomy or no surgical metastasectomy at all.

The meta-analysis included 8 published cohort studies that reported on 2,267 patients: 958 who underwent complete metastasectomy and 1,309 who did not. The majority of patients had clear cell or clear cell component histology.

The studies showed a median overall survival ranging from 36.5 months to 142 months for those who underwent complete metastasectomy. In contrast, patients who did not undergo complete metastasectomy had a median overall survival that ranged from 8.4 to 27 months. Patients who did undergo complete metastasectomy had a reduced risk of all-cause mortality (adjusted HR, 2.37 [95% CI, 2.03–2.87]; P < .001). All a priori subgroup and sensitivity analyses produced an adjusted HR greater than 2.

According to the researchers, published studies “offer additional insight into this topic and suggest a broader role for complete metastasectomy.”

“Indeed, the majority of studies in this meta-analysis (6/8) included patients with metastases to multiple organ sites (36% to 55.8% of patients), suggesting that even those with non-solitary metastases may benefit from complete metastasectomy,” they wrote.