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Prognostic value of cytoreductive nephrectomy combined with targeted therapy for metastatic renal cell carcinoma: a meta-analysis

  • Urology - Original Paper
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Abstract

Purpose

The role of cytoreductive nephrectomy (CN) has been controversial with the advent of targeted therapy. Our study was to identify the prognostic value of CN combined with targeted therapy for treatment of metastatic renal cell carcinoma (mRCC) by conducting a meta-analysis based on the existing population-based studies.

Methods

Research articles published up to September 2015 were searched through PubMed and Embase. A meta-analysis was performed to assess the overall survival (OS) and progression-free survival (PFS) of patients with mRCC undergoing CN combined with targeted therapy compared with targeted therapy alone. Furthermore, analysis was made to evaluate some potential prognostic factors predicting survival.

Results

Eight studies were included in our analysis with 2688 mRCC patients. A fixed-effect model was performed and found the pooled HR of OS was 0.60 (95 % CI 0.53–0.67, p < 0.0001). Furthermore, the pooled median survival ratio was elevated (HR 2.11, 95 % CI 1.78–2.49, p < 0.0001), indicating that patients who received CN combined with targeted therapy yielded a more than twofold prolonged OS compared with those who received targeted therapy alone. Moreover, no significant difference was observed in PFS in the patients undergoing CN combined with targeted therapy (HR 0.82, 95 % CI 0.57–1.19, p = 0.30).

Conclusions

Current evidence suggests that CN combined with targeted therapy has a significant OS advantage in patients with mRCC. However, the results should be evaluated in the context of the potential selection biases of the existing evidence. Large prospective cohort studies are required to confirm these findings.

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Acknowledgments

The authors would like to thank all authors of the included studies in our meta-analysis.

Author contributions

Xuwei Hong and Fei Li conducted analysis and wrote the manuscript; Kaiqiang Tang and Shiyu Pang were involved in data collection and management; Guangzheng Lin verified the data; Shi Li assisted in statistical analyses; Jiming Bao edited figures and tables; Wanlong Tan was involved in project development and proofread the manuscript.

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    Authors and Affiliations

    1. Department of Urology, Nanfang Hospital, Southern Medical University, No. 1838, North of Guangzhou Avenue, Guangzhou, 510515, Guangdong Province, People’s Republic of China

      Xuwei Hong, Fei Li, Kaiqiang Tang, Shiyu Pang, Guangzheng Lin, Shi Li, Jiming Bao & Wanlong Tan

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    1. Xuwei Hong
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    2. Fei Li
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    Correspondence to Wanlong Tan.

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    The authors declare that they have no conflicts of interest.

    Ethical approval

    As the study was a meta-analysis based on the existing population-based studies, we did not apply for the approval of institutional review board.

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    Xuwei Hong and Fei Li have contributed equally to the present work.

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    Hong, X., Li, F., Tang, K. et al. Prognostic value of cytoreductive nephrectomy combined with targeted therapy for metastatic renal cell carcinoma: a meta-analysis. Int Urol Nephrol 48, 967–975 (2016). https://doi.org/10.1007/s11255-016-1233-z

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    • DOI: https://doi.org/10.1007/s11255-016-1233-z

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