There is evidence that cytoreductive nephrectomy (CN) may be beneficial in metastatic renal cell carcinoma (mRCC). This has been studied predominantly in clear-cell RCC, with more limited data on the role of CN in patients with papillary histology.

To determine the benefit of CN in synchronous metastatic papillary RCC.

Using the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) database, a retrospective analysis was performed for patients with papillary mRCC treated with or without CN.

Median overall survival (OS) and progression-free survival (PFS) were determined for both patient groups. Cox regression analysis was performed to control for imbalances in individual IMDC risk factors.

In total, 647 patients with papillary mRCC were identified, of whom 353 had synchronous metastatic disease. Of these, 109 patients were treated with CN and 244 were not. The median follow-up was 57.1mo (95% confidence interval [CI] 32.9-77.8) and the OS from the start of first-line targeted therapy for the entire cohort was 13.2mo (95% CI 12.0-16.1). Median OS for patients with CN was 16.3mo, compared to 8.6mo (p<0.0001) in the no-CN group. When adjusted for individual IMDC risk factors, the hazard ratio (HR) of death for CN was 0.62 (95% CI 0.45-0.85; p=0.0031). Limitations include the retrospective nature of the analysis.

The use of CN in patients with mRCC and papillary histology appears to be associated with better survival compared to no CN after adjustment for risk criteria. Selection of appropriate candidates for CN is crucial. A clinical trial in this rare population may not be possible.

In a population of patients with advanced papillary kidney cancer, we found that surgical removal of the primary kidney tumor was associated with better overall survival.

European urology oncology. 2019 Apr 04 [Epub ahead of print]

Jeffrey Graham, J Connor Wells, Frede Donskov, Jae Lyun Lee, Anna Fraccon, Felice Pasini, Camillo Porta, I Alex Bowman, Georg A Bjarnason, D Scott Ernst, Sun Young Rha, Benoit Beuselinck, Aaron Hansen, Scott A North, Christian K Kollmannsberger, Lori A Wood, Ulka N Vaishampayan, Sumanta K Pal, Toni K Choueiri, Daniel Y C Heng

Tom Baker Cancer Centre, University of Calgary, Calgary, Canada., Aarhus University Hospital, Aarhus, Denmark., University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea., CDC Pererzoli, Peschiera del Garda, Italy., Oncologia Medica Ospedale Santa Maria della Misericordia, Rovigo, Italy., University of Pavia, Pavia, Italy., UT Southwestern Medical Center, Dallas, TX, USA., Sunnybrook Research Institute, Toronto, Canada., London Health Sciences Centre, London, Canada., Yonsei University College of Medicine, Seoul, Republic of Korea., University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium., Princess Margaret Cancer Centre, Toronto, Canada., University of Alberta, Cross Cancer Institute, Edmonton, Canada., British Columbia Cancer Agency, Vancouver, Canada., QEII Health Sciences Centre, Halifax, Canada., Karmanos Cancer Center, Detroit, MI, USA., City of Hope Comprehensive Cancer Center, Duarte, CA, USA., Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA., Tom Baker Cancer Centre, University of Calgary, Calgary, Canada. Electronic address: .