Introduction

Cytoreductive nephrectomy (CN) for patients with metastatic clear cell RCC (ccRCC) has been shown to be beneficial in 2 prospective clinical trials as well as several retrospective studies. However, studies on CN in patients with non-clear cell RCC(nccRCC) are scarce and conflicting. Our aim was to evaluate if CN was associated with a survival advantage for patients with metastatic nccRCC.

Methods

We retrospectively reviewed the clinical characteristics and outcomes of patients with metastatic nccRCC who either underwent CN followed by systemic therapy or were treated with systemic therapy alone (no CN), and were followed at our institution prior to January 2016. Fisher’s exact test, chi-square and Kruskal-Wallis tests were used to compare demographic and clinical characteristics of the patients. Overall Survival (OS) was estimated using Kaplan-Meier product-limit estimator and modeled with Cox proportional hazards regression.

Results

129 patients with metastatic nccRCC underwent CN and 306 patients did not. Median overall survival for the CN and no CN groups were 1.49 and 0.59 years, respectively (p<0.001). Patient demographic characteristics are summarized in Table 1. 3-year survival probabilities were 0.04 and 0.23 for the no CN group and CN group, respectively (p<0.001, Figure 1). CN group had lower rates of death compared to the no CN group (HR:0.40; 95% CI:0.28 – 0.56; p<0.001). Larger tumor size, lower ECOG performance status and higher T stage were found to be independent risk factors for worse overall survival.

Conclusions

CN in the setting of nccRCC was associated with an apparent survival advantage, and should be performed in well-selected patients with metastatic nccRCC.

Funding

none