Abstract
Renal cell carcinoma (RCC) accounts for approximately 3% of all malignant tumors, and 15% of tumors are metastatic at time of diagnosis. For many years, cytoreductive nephrectomy was the mainstay of treatment.
For the patients with metastatic disease, cytoreductive nephrectomy (CN) is predominantly a palliative procedure and systemic therapy is essential. Adrenalectomy as a part of CN is not considered as a standard part of the procedure except for obvious tumor invasion into the adrenal gland.
Lymfadenectomy as a part of CN has only staging effect. Results of cytokine study comparing CN plus interferon-based immunotherapy vs. interferon immunotherapy alone have shown improved overall survival (OS) in patients treated with CN.
However, treatment options have rapidly expanded thanks to introduction of therapies targeting the molecular mechanisms underlying RCC carcinogenesis. From the point of view of today's modern oncology, the question is in whom and when to include nephrectomy in the treatment of mRCC.
Results from the CARMENA and SURTIME studies have shown that patients who require systematic therapy benefit from immediate medical treatment. Sunitinib alone is non-inferior compared with immediate CN followed by sunitinib in patients with intermediate and low risk MSKCC who require systemic therapy.
Exploratory results from the studies show that IO + IO (IO - immunotherapy) or TKI + IO (TKI - tyrosin kinase inhibitor) combination have better effect on primary tumor and metastasis in the comparison with sunitinib alone. Patients with retained primary tumor treated with IO-based combination therapy have better progression-free survival and OS in exploratory subgroup analyzes compared with sunitinib treatment.
In mRCC patients with a clinical response to the combination based on IO subsequent CN can be considered. The aim of this study is to define the role, current status and timing of surgical treatment in metastatic disease.