Skip to main content

Advertisement

SpringerLink
Log in

Do patients with metastatic renal cell carcinoma obtain survival benefits from cytoreductive nephrectomy? A population-based study

  • Research
  • Published:
Journal of Cancer Research and Clinical Oncology Aims and scope Submit manuscript

Abstract

Purpose

This study aimed to explore the value of cytoreductive nephrectomy (CN) and develop nomograms to predict the prognosis of metastatic renal cell carcinoma (mRCC) patients with receiving radiology therapy or/and chemotherapy (RT/&CT).

Methods

Clinical data of patients with mRCC between 2010 and 2015 were collected from the Surveillance, Epidemiology, and End Results (SEER) database. Prognostic nomograms were constructed to predict the overall survival (OS) and cancer-specific survival (CSS) probability for 1-, 3-, and 5- years in patients with mRCC. A series of validation methods were used to validate the accuracy and reliability of the model, including area under the receiver operating curve (AUC), consistency index (C-index), calibration curve, and decision curve analysis (DCA).

Results

1394 patients were enrolled in this study. All patients were randomly divided into the training cohort (n = 976) and the validation cohort (n = 418). In the training cohort, multivariate Cox regression analysis suggested that pathology grade, histology type, T stage, N stage, surgery, and distant metastasis were independent risk factors for OS and CSS. The AUC and C-index were both over 0.65 in both cohorts, indicating that the nomograms for OS and CSS had satisfactory discriminative power. The calibration curves revealed that the predictive nomograms had a good consistency between the observed and the predicted survival.

Conclusion

This study provided evidence that mRCC patients underwent RT/&CT could gain survival benefits from CN. The prognostic nomogram constructed in our study is reliable and practical, may help guide clinical strategies in the treatment of mRCC.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

Data availability

All the data were presented in the manuscript and supplementary material. No additional data are available.

References

  • Abdel-Rahman O (2017) Clinical correlates and prognostic value of different metastatic sites in metastatic renal cell carcinoma. Future Oncol 13(22):1967–1980

    PubMed  Google Scholar 

  • Barrisford GW, Gershman B Sr, BML. (2014) The role of lymphadenectomy in the management of renal cell carcinoma. World J Urol 32(3):643–649

    PubMed  Google Scholar 

  • Berger DA, Megwalu II, Vlahiotis A, Radwan MH, Serrano MF, Humphrey PA et al (2008) Impact of comorbidity on overall survival in patients surgically treated for renal cell carcinoma. Urology 72(2):359–363

    PubMed  Google Scholar 

  • Bex A, Albiges L, Ljungberg B, Bensalah K, Dabestani S, Giles RH et al (2018) Updated European association of urology guidelines for cytoreductive nephrectomy in patients with synchronous metastatic clear-cell renal cell carcinoma. Eur Urol 74(6):805–809

    PubMed  Google Scholar 

  • Bhindi B, Abel EJ, Albiges L, Bensalah K, Boorjian SA, Daneshmand S et al (2019) Systematic review of the role of cytoreductive nephrectomy in the targeted therapy era and beyond: an individualized approach to metastatic renal cell carcinoma. Eur Urol 75(1):111–128

    PubMed  Google Scholar 

  • Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A (2018) Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 68(6):394–424

    PubMed  Google Scholar 

  • Capitanio U, Becker F, Blute ML, Mulders P, Patard JJ, Russo P et al (2011) Lymph node dissection in renal cell carcinoma. Eur Urol 60(6):1212–1220

    PubMed  Google Scholar 

  • Chandrasekar T, Klaassen Z, Goldberg H, Kulkarni GS, Hamilton RJ, Fleshner NE (2017) Metastatic renal cell carcinoma: patterns and predictors of metastases-A contemporary population-based series. Urol Oncol 35(11):661.e7-661.e14

    PubMed  Google Scholar 

  • Cronin KA, Ries LA, Edwards BK (2014) The surveillance, epidemiology, and end results (SEER) Program of the National Cancer Institute. Cancer 120(Suppl 23):3755–3757

    PubMed  Google Scholar 

  • Daugherty M, Daugherty E, Jacob J, Shapiro O, Mollapour M, Bratslavsky G (2019) Renal cell carcinoma and brain metastasis: Questioning the dogma of role for cytoreductive nephrectomy. Urol Oncol 37(3):182.e9-182.e15

    PubMed  Google Scholar 

  • Debien V, Thouvenin J, Lindner V, Barthélémy P, Lang H, Flippot R et al (2019) Sarcomatoid dedifferentiation in renal cell carcinoma: from novel molecular insights to new clinical opportunities. Cancers 12(1):99

    PubMed  PubMed Central  Google Scholar 

  • Dekernion JB, Ramming KP, Smith RB (1978) The natural history of metastatic renal cell carcinoma: a computer analysis. J Urol 120(2):148–152

    CAS  PubMed  Google Scholar 

  • Delahunt B, Cheville JC, Martignoni G, Humphrey PA, Magi-Galluzzi C, McKenney J et al (2013) The International Society of Urological Pathology (ISUP) grading system for renal cell carcinoma and other prognostic parameters. Am J Surg Pathol 37(10):1490–1504

    PubMed  Google Scholar 

  • DiNatale RG, Xie W, Becerra MF, Silagy AW, Attalla K, Sanchez A et al (2020) The Association between small primary tumor size and prognosis in metastatic renal cell carcinoma: insights from two independent cohorts of patients who underwent cytoreductive nephrectomy. Eur Urol Oncol 3(1):47–56

    PubMed  Google Scholar 

  • Ditonno P, Traficante A, Battaglia M, Grossi FS, Selvaggi FP (1992) Role of lymphadenectomy in renal cell carcinoma. Prog Clin Biol Res 378:169–174

    CAS  PubMed  Google Scholar 

  • Flanigan RC, Salmon SE, Blumenstein BA, Bearman SI, Roy V, McGrath PC et al (2001) Nephrectomy followed by interferon alfa-2b compared with interferon alfa-2b alone for metastatic renal-cell cancer. N Engl J Med 345(23):1655–1659

    CAS  PubMed  Google Scholar 

  • Fuhrman SA, Lasky LC, Limas C (1982) Prognostic significance of morphologic parameters in renal cell carcinoma. Am J Surg Pathol 6(7):655–663

    CAS  PubMed  Google Scholar 

  • Gan CL, Dudani S, Heng D (2020) Prognostic and predictive factors in metastatic renal cell carcinoma: current perspective and a look into the future. Cancer J 26(5):365–375

    CAS  PubMed  Google Scholar 

  • Horsbøl TA, Dalton SO, Christensen J, Petersen AC, Azawi N, Donskov F et al (2022) Impact of comorbidity on renal cell carcinoma prognosis: a nationwide cohort study. Acta Oncol 61(1):58–63

    PubMed  Google Scholar 

  • Iasonos A, Schrag D, Raj GV, Panageas KS (2008) How to build and interpret a nomogram for cancer prognosis. J Clin Oncol 26(8):1364–1370

    PubMed  Google Scholar 

  • Kader AK, Tamboli P, Luongo T, Matin SF, Bell K, Jonasch E et al (2007) Cytoreductive nephrectomy in the elderly patient: the M. D. Anderson Cancer Center experience. J Urol 177(3):855–860

    PubMed  Google Scholar 

  • Kanesvaran R, Le Saux O, Motzer R, Choueiri TK, Scotté F, Bellmunt J et al (2018) Elderly patients with metastatic renal cell carcinoma: position paper from the International Society of Geriatric Oncology. Lancet Oncol 19(6):e317–e326

    PubMed  Google Scholar 

  • Li S, Zhu J, He Z, Ashok R, Xue N, Liu Z et al (2022) Development and validation of nomograms predicting postoperative survival in patients with chromophobe renal cell carcinoma. Front Oncol 12:982833

    PubMed  PubMed Central  Google Scholar 

  • Li J, Li X, Jiang Z, Hu C, Liu J, Huo J et al (2022) Predicting the probability of malignant pathological type of kidney cancer based on mass size: a retrospective study. Prog Urol 32(12):849–855

    CAS  PubMed  Google Scholar 

  • Lin S, Zheng Y, Qin Z, Hu X, Qi F, Yin R et al (2019) Surgical intervention in renal cell carcinoma patients with lung and bronchus metastasis is associated with longer survival time: a population-based analysis. Ann Transl Med 7(14):323

    CAS  PubMed  PubMed Central  Google Scholar 

  • Ljungberg B, Albiges L, Abu-Ghanem Y, Bedke J, Capitanio U, Dabestani S et al (2022) Association of urology guidelines on renal cell carcinoma: the 2022 update. Eur Urol 82(4):399–410

    PubMed  Google Scholar 

  • Méjean A, Ravaud A, Thezenas S, Colas S, Beauval JB, Bensalah K et al (2018) Sunitinib alone or after nephrectomy in metastatic renal-cell carcinoma. N Engl J Med 379(5):417–427

    PubMed  Google Scholar 

  • Moch H, Cubilla AL, Humphrey PA, Reuter VE, Ulbright TM (2016) The 2016 WHO classification of tumours of the urinary system and male genital organs-part A: renal, penile, and testicular tumours. Eur Urol 70(1):93–105

    PubMed  Google Scholar 

  • Motzer RJ, Russo P (2018) Cytoreductive Nephrectomy - Patient Selection Is Key. N Engl J Med 379(5):481–482

    PubMed  Google Scholar 

  • Motzer RJ, Bacik J, Murphy BA, Russo P, Mazumdar M (2002) Interferon-alfa as a comparative treatment for clinical trials of new therapies against advanced renal cell carcinoma. J Clin Oncol 20(1):289–296

    CAS  PubMed  Google Scholar 

  • Palumbo C, Knipper S, Dzyuba-Negrean C, Pecoraro A, Rosiello G, Tian Z et al (2020) Complication rates, failure to rescue and in-hospital mortality after cytoreductive nephrectomy in the older patients. J Geriatr Oncol 11(4):718–723

    PubMed  Google Scholar 

  • Patel MI, Beattie K, Bang A, Gurney H, Smith DP (2017) Cytoreductive nephrectomy for metastatic renal cell carcinoma: inequities in access exist despite improved survival. Cancer Med 6(10):2188–2193

    PubMed  PubMed Central  Google Scholar 

  • Patel HD, Karam JA, Allaf ME (2018) Surgical management of advanced kidney cancer: the role of cytoreductive nephrectomy and lymphadenectomy. J Clin Oncol. https://doi.org/10.1200/JCO.2018.79.0246

    Article  PubMed  PubMed Central  Google Scholar 

  • Russo P (2004) Surgical intervention in patients with metastatic renal cancer: current status of metastasectomy and cytoreductive nephrectomy. Nat Clin Pract Urol 1(1):26–30

    PubMed  Google Scholar 

  • Silagy AW, Flynn J, Mano R, Blum KA, Marcon J, DiNatale RG et al (2019) Clinicopathologic features associated with survival after cytoreductive nephrectomy for nonclear cell renal cell carcinoma. Urol Oncol 37(11):811.e9-811.e16

    PubMed  Google Scholar 

  • Silagy AW, Attalla K, Dinatale RG, Weiss KL, Weng S, Mano R et al (2021) A qualitative framework of non-selection factors for cytoreductive nephrectomy. World J Urol 39(9):3359–3365

    PubMed  PubMed Central  Google Scholar 

  • Tatsumi T, Herrem CJ, Olson WC, Finke JH, Bukowski RM, Kinch MS et al (2003) Disease stage variation in CD4+ and CD8+ T-cell reactivity to the receptor tyrosine kinase EphA2 in patients with renal cell carcinoma. Cancer Res 63(15):4481–4489

    CAS  PubMed  Google Scholar 

  • Turajlic S, Xu H, Litchfield K, Rowan A, Horswell S, Chambers T et al (2018) Deterministic evolutionary trajectories influence primary tumor growth: TRACERx renal. Cell 173(3):595-610.e11

    CAS  PubMed  PubMed Central  Google Scholar 

  • Vig S, Zan E, Kang SK (2020) Imaging for metastatic renal cell carcinoma. Urol Clin North Am 47(3):281–291

    PubMed  PubMed Central  Google Scholar 

  • Wang J, Zhanghuang C, Tan X, Mi T, Liu J, Jin L et al (2022) Development and validation of a nomogram to predict distant metastasis in elderly patients with renal cell carcinoma. Front Public Health 9:831940

    PubMed  PubMed Central  Google Scholar 

  • Wang J, Wen Q, Wang X, Liu C, Zhao K, Li Y et al (2022) Nomogram for predicting cancer-specific survival of patients with clear-cell renal cell carcinoma: a SEER-based population study. Gen Physiol Biophys 41(6):591–601

    PubMed  Google Scholar 

  • You D, Jeong IG, Song C, Lee JL, Hong B, Hong JH et al (2015) Analysis of pre-operative variables for identifying patients who might benefit from upfront cytoreductive nephrectomy for metastatic renal cell carcinoma in the targeted therapy era. Jpn J Clin Oncol 45(1):96–102

    PubMed  Google Scholar 

  • Zastrow S, Phuong A, von Bar I, Novotny V, Hakenberg OW, Wirth MP (2014) Primary tumor size in renal cell cancer in relation to the occurrence of synchronous metastatic disease. Urol Int 92(4):462–467

    PubMed  Google Scholar 

  • Zerdes I, Tolia M, Tsoukalas N, Mitsis M, Kardamakis D, Pistevou-Gombaki K et al (2019) Systemic therapy of metastatic renal cell carcinoma: review of the current literature. Urologia 86(1):3–8

    PubMed  Google Scholar 

  • Zheng R, Zhang S, Zeng H, Wang S, Sun K, Chen R et al (2022) Cancer incidence and mortality in China, 2016. J Natl Cancer Cent 2(1):1

    Google Scholar 

Download references

Acknowledgements

We sincerely thank the SEER database in providing high quality clinical data for our research. We also gratefully acknowledge Ruihuan Shen and Ziqi Pan for their professional statistical help.

Funding

No funding was received.

Author information

Author notes

  1. Zhenkai Luo, Binbin Jiao and Qianwen Xu have contributed to the work equally and should be regarded as co-first authors.

Authors and Affiliations

  1. Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China

    Zhenkai Luo

  2. Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China

    Zhenkai Luo

  3. Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 266000, China

    Binbin Jiao & Weifeng He

  4. Department of Pediatrics, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, 266318, China

    Qianwen Xu

  5. Peking University, China-Japan Friendship School Clinical Medicine, Beijing, 100029, China

    Hang Zhao, Yuhao Liu, Haijie Chen & Yunfan Guan

  6. Department of Urology, China-Japan Friendship Hospital, Beijing, 100029, China

    Hang Zhao, Yuhao Liu, Haijie Chen, Yunfan Guan & Guan Zhang

  7. Department of Urology, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, 450003, China

    Zhaoqiang Jiang

Authors
  1. Zhenkai Luo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Binbin Jiao
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Qianwen Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Weifeng He
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hang Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yuhao Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Haijie Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yunfan Guan
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Guan Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Zhaoqiang Jiang
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Study design: ZJ, GZ; data collection: QX, WH, HZ, BJ; data analysis and interpretation: YL, HC, YG, ZL; manuscript writing: ZL, BJ.

Corresponding author

Correspondence to Guan Zhang.

Ethics declarations

Conflict of interest

The authors declared that this study has received no financial support and there was no conflict of interest.

Ethical approval

The data of this study is obtained from the SEER database. Therefore the ethical approval and informed consent is not applicable.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

432_2023_4885_MOESM1_ESM.tif

Supplementary file1 Figure S1. The Kaplan-Meier curves of OS grouped by clinicopathological variables in the whole population, including Age (≥65, <65) (A,B), Race (White, Black and Other) (C,D), Sex (Male, Female) (E,F), Marital status (Married, Not married) (G,H), Laterality (Left, Right) (I,J), Grade (I and II, III, IV) (K-M), T stage (T1, T2, T3, T4) (N-Q), N stage (N0, N1) (R,S), Histologic type (ccRCC, pRCC and chRCC and CDC) (T,U), and distant metastasis (Bone, Brain, Liver, Lung) (V-Y) (TIF 15854 KB)

432_2023_4885_MOESM2_ESM.tif

Supplementary file2 Figure S2. The Kaplan-Meier curves of CSS grouped by clinicopathological variables in the whole population, including Age (≥65, <65) (A,B), Race (White, Black and Other) (C,D), Sex (Male, Female) (E,F), Marital status (Married, Not married) (G,H), Laterality (Left, Right) (I,J), Grade (I and II, III, IV) (K-M), T stage (T1, T2, T3, T4) (N-Q), N stage (N0,N1) (R,S), Histologic type (ccRCC, pRCC and chRCC and CDC) (T,U), and distant metastasis (Bone, Brain, Liver, Lung) (V-Y) (TIF 15854 KB)

432_2023_4885_MOESM3_ESM.tif

Supplementary file3 Figure S3. The Kaplan-Meier curves of OS in single metastatic site (A), 2 metastatic sites (B) and 3-4 metastatic sites (C); The Kaplan-Meier curves of CSS in single metastatic site (D), 2 metastatic sites (E) and 3-4 metastatic sites (F) (TIF 10573 KB)

Supplementary file4 Figure S4. An example for the practical application of the nomogram (TIF 3502 KB)

Supplementary file5 (DOCX 13 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Luo, Z., Jiao, B., Xu, Q. et al. Do patients with metastatic renal cell carcinoma obtain survival benefits from cytoreductive nephrectomy? A population-based study. J Cancer Res Clin Oncol 149, 9657–9670 (2023). https://doi.org/10.1007/s00432-023-04885-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00432-023-04885-x

Keywords

Search

Navigation