The effect of metastasectomy on overall survival in metastatic renal cell carcinoma: A systematic review and meta-analysis |
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| Authors: | Po-Yen Hsieh Sheng-Chun Hung Jian-Ri Li Shian-Shiang Wang Cheng-Kuang Yang Chuan-Shu Chen Kevin Lu Cheng-Li Cheng Kun-Yuan Chiu |
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| Institution: | 1. Department of Education, Taichung Veterans General Hospital, Taichung, Taiwan;2. School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan;3. Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan;4. Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan;5. Department of Medicine and Nursing, Hungkuang University, Taichung, Taiwan;6. Department of Applied Chemistry, National Chi Nan University, Nantou, Taiwan;7. School of Medicine, National Yang Ming University, Taipei, Taiwan |
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| Abstract: | PurposeMetastasectomy (MTS) is a treatment option for patients diagnosed with metastatic Renal Cell Carcinoma (mRCC). Nevertheless, the benefits of MTS as they pertain to survival remain controversial. This systematic review aims to compare the survival outcomes of patients who underwent MTS, as well as discover which clinical factors were related to the results.MethodsFrom their inception up to August 2020, a systematic review of the EMBASE, PubMed, Cochrane library, and Web of science databases was performed. Studies which reported outcomes on patients who underwent MTS for the treatment of mRCC were included. The sites, times, amount, histology types of metastasis, and prior nephrectomy were also analyzed. The primary efficacy end point was Overall Survival (OS). A meta-analysis was performed to calculate hazard ratio, 95% confidence intervals, and I2 values. Forest plots were constructed for each analysis group.ResultsThe systematic review and reference list search identified 294 articles, with 17 meeting studies as inclusion criteria. The MTS group showed a competitive advantage in OS, in that the non-MTS group was negatively associated with an overall survival rate (HR non-MTS vs. MTS] = 2.15, 95% CI: 1.59–2.92, P< 0.001). Moreover, patients treated with the most recently available target therapy without MTS showed a significantly increased risk compared with the MTS group (HR = 1.82, 95% CI:1.23–2.70, P= 0.003). Additionally, meta-analysis revealed HR elevating in patients with nonlung only metastasis (HR = 1.87, 95% CI: 1.55–2.26, P< 0.001), synchronous metastasis (HR = 1.28, 95% CI: 1.10–1.49, P= 0.001), and multiple metastases (HR = 2.06, 95% CI: 1.64–2.59, P< 0.001). Clear-cell type mRCC (HR = 0.62, 95% CI: 0.48–0.82, P= 0.0006) and prior nephrectomy (HR = 0.37, 95% CI: 0.15–0.91, P= 0.03) were positively associated with a better overall survival rate.ConclusionsMTS is a treatment option for mRCC patients with prolonged overall survival time. The operation has additional advantages, particularly in patients with lung only metastasis, asynchronous metastasis, fewer metastasis sites, clear-cell type mRCC, and the patients who had received nephrectomy. |
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