Predictors of survival after cytoreductive nephrectomy in metastatic renal cell carcinoma: A Real-world perspective

ABSTRACT Introduction: Existing retrospective evidence suggests cytoreductive nephrectomy (CN) may benefit patients suffering metastatic renal cell carcinoma, but optimal patient selection criteria are unclear. We evaluated outcomes following CN to identify factors influencing survival to guide patient selection. Methods: We retrospectively reviewed patients who underwent CN from January 2011 to December 2023. Data on demographics, treatment, and survival outcomes were analyzed. Kaplan–Meier estimates calculated progression-free survival (PFS) and overall survival (OS). Cox regression models identified prognostic factors. Results: Of 1346 surgeries performed for RCC during the study period, 63 were performed with cytoreductive intent. Median (IQR) age was 57 (50–65) years, and 79.4% were male. Median PFS was 13.0 (95% confidence interval CI, 2.5–23.5) months. Diabetes mellitus (DM) (hazard ratio HR 2.4, 95% CI 1.1–5.5, P = 0.03) and presentation with systemic symptoms (SS) (HR 3.0, 95% CI 1.4–6.7, P = 0.01) were associated with shorter PFS. Median OS was 54.0 (95% CI, 22.7–85.3) months. Multiple metastatic sites (HR 4.5, 95% CI 1.4–14.3, P = 0.01), rhabdoid differentiation (RD) (HR 3.5, 95% CI 1.1–10.9, P = 0.03), sarcomatoid differentiation (SD) (HR 4.3, 95% CI 1.2–16.1, P = 0.03), and DM (HR 5.4, 95% CI 1.8–16.0, P < 0.01) predicted worse OS. Conversely, year of diagnosis ≥ 2019 was associated with better PFS (HR 0.9, 95% CI 0.8–0.9, P = 0.03) and OS (HR 0.7, 95% CI 0.6–0.8, P < 0.01). Conclusion: The presence of a single site of metastasis is associated with better OS after CN and can serve as a useful criterion to select patients that are most likely to derive benefit from CN. Presentation with SS, RD/SD, and DM predicts poorer outcomes, informing decision-making for CN in metastatic renal cell carcinoma.