(1) Background: The role of cytoreductive nephrectomy (CN) is controversial in patients with primary metastatic renal cell carcinoma (mRCC). (2) Methods: We evaluated the impact of CN, or no CN, followed by first-line targeted therapy (TT) in a nationwide unselected cohort of 437 consecutive patients with primary mRCC over a two-year period with a minimum of five years of follow-up. Data sources were national registries supplemented with manually extracted information from individual patient medical records. Cox proportional hazards estimated the hazard ratio (HR) of overall death and cancer-specific death after one and three years. (3) Results: 210 patients underwent CN and 227 did not. A total of 176 patients (40%) had CN followed by TT, 160 (37%) had TT alone, 34 (8%) underwent CN followed by observation, and 67 (15%) received no treatment. After adjustments in Model 2, patients treated with TT alone demonstrated a worsened overall survival (OS) compared to those treated with CN + TT, HR 0.63 (95% CI: 0.19–2.04). (4) Conclusions: In this nationwide study, CN was associated with enhanced outcomes in carefully selected patients with primary mRCC. Further randomized trials are warranted.
(1) 背景：对于原发性转移性肾细胞癌（mRCC）患者，减瘤性肾切除术（CN）的作用存在争议。(2) 方法：我们基于全国性非选择性队列，对437例连续收治的原发性mRCC患者进行了为期两年、至少五年随访的评估，分析接受或不接受CN后序贯一线靶向治疗（TT）的疗效差异。数据来源于国家登记系统，并辅以从患者个体医疗记录中人工提取的信息。采用Cox比例风险模型估算一年及三年后总死亡和癌症特异性死亡的风险比（HR）。(3) 结果：210例患者接受了CN，227例未接受。共计176例患者（40%）接受CN后序贯TT，160例（37%）仅接受TT，34例（8%）接受CN后仅观察，67例（15%）未接受任何治疗。经模型2调整后，与接受CN+TT治疗的患者相比，仅接受TT治疗的患者总生存期（OS）更差，HR为0.63（95% CI：0.19–2.04）。(4) 结论：在这项全国性研究中，CN与经过严格筛选的原发性mRCC患者预后改善相关。仍需进一步随机试验验证。
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