Background: The optimal timing of cytoreductive nephrectomy (CN) in metastatic renal cell carcinoma (mRCC) remains a subject of debate, particularly in the immunotherapy era. This study compares survival outcomes between deferred CN (dCN) and upfront CN (uCN) in mRCC patients receiving modern immunotherapy regimens in the real-world setting. Methods: We retrospectively analyzed the SEER database for mRCC patients diagnosed between 2016 and 2021 who underwent dCN or uCN. The primary endpoint was overall survival (OS), while the secondary endpoints were disease-specific survival (DSS) and other-cause specific survival (OCSS). Statistical analyses included propensity score matching (PSM), Kaplan–Meier survival curves, Cox proportional hazards modeling, as well as sensitivity, subgroup, and landmark analyses. Results: A total of 1892 mRCC patients were included, with 346 patients (18.3%) undergoing dCN and 1546 patients (81.7%) receiving uCN. Patients in the uCN group were characterized with lower T stage (p< 0.001), while those in the dCN group exhibited a higher incidence of lymph node involvement (p= 0.02) and sarcomatoid dedifferentiation (p= 0.002). Following 1:2 PSM, dCN demonstrated significantly better OS and DSS, but comparable OCSS to uCN. The sensitivity and subgroup analyses suggested that dCN may substantially improve the prognosis of mRCC patients across conditions. The landmark analysis showed that the survival advantage of dCN diminished after two years of follow-up. Conclusions: dCN may be associated with improved survival outcomes compared to uCN in selected mRCC patients receiving immunotherapy, and careful patient selection for dCN or uCN is essential.
背景：转移性肾细胞癌（mRCC）患者行减瘤性肾切除术（CN）的最佳时机仍存在争议，尤其在免疫治疗时代。本研究旨在真实世界环境中，比较接受现代免疫治疗方案mRCC患者中延迟减瘤性肾切除术（dCN）与即刻减瘤性肾切除术（uCN）的生存结局。方法：我们回顾性分析了2016年至2021年间诊断为mRCC并接受dCN或uCN治疗的SEER数据库患者。主要终点为总生存期（OS），次要终点为疾病特异性生存期（DSS）和其他原因特异性生存期（OCSS）。统计分析包括倾向评分匹配（PSM）、Kaplan-Meier生存曲线、Cox比例风险模型，以及敏感性分析、亚组分析和界标分析。结果：共纳入1892例mRCC患者，其中346例（18.3%）接受dCN，1546例（81.7%）接受uCN。uCN组患者T分期较低（p<0.001），而dCN组患者淋巴结受累（p=0.02）和肉瘤样去分化（p=0.002）发生率更高。经1:2 PSM后，dCN在OS和DSS方面显著优于uCN，但OCSS与uCN相当。敏感性分析和亚组分析表明，dCN可能在不同条件下显著改善mRCC患者的预后。界标分析显示，dCN的生存优势在随访两年后逐渐减弱。结论：在接受免疫治疗的特定mRCC患者中，dCN可能比uCN带来更好的生存结局，因此对dCN或uCN的患者进行审慎选择至关重要。
肿瘤(癌症)患者之家