Role of cytoreductive nephrectomy (CRN) for metastatic renal cell carcinoma (mRCC) in the era of targeted therapy (TKI): experience from three hong kong tertiary centres

Abstract

Objective: Investigate the practice of CRN and TKI in treatment of mRCC in three tertiary centres in Hong Kong.

Patients & Methods: Metastatic RCC patients with either CRN or TKI from 2006 to 2013 in three tertiary centres were studied. Primary endpoint is the overall survival (OS) while secondary endpoint is the time to progression. All CRN group was compared with TKI group and subgroup analysis of CRN + TKI (post CRN target given) versus TKI was performed as well.

Results: A total of 73 patients were reviewed, with 41 (56%) in CRN group while 32 (44%) in TKI group. For the CRN (with or without subsequent TKI) group versus TKI only, 48.8% patients survived versus 12.5% respectively (p = 0.01) while 77.5% patients progressed versus 78.1% respectively (p = 0.89). For the CRN group, 22 patients (53.7%) received immediate target therapy while 19 patients (46.3%) did not. For the post nephrectomy pathology 89.3% (25 patients) yielded clear cell RCC and with 11.1% T1, 29.6% T2, 55.6% T3, and 3.7% T4 tumours. The most commonly used TKI agents were sunitinib (76.9%) followed by sorafenib (11.5%) and pazopanib (7.7%).

Conclusion: Our study reflects the current practice of treatment for metastatic RCC in the era of targeted therapy.