دورية أكاديمية
أعرض في EDS

Cytoreductive nephrectomy in metastatic renal cell carcinoma.

التفاصيل البيبلوغرافية
العنوان: Cytoreductive nephrectomy in metastatic renal cell carcinoma.
المؤلفون: Dahm P; Urology Section, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA.; Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA., Ergun O; Urology Section, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA.; Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA., Uhlig A; Department of Urology, University Medical Center, Goettingen, Germany.; UroEvidence@Deutsche Gesellschaft für Urologie, Berlin, Germany., Bellut L; UroEvidence@Deutsche Gesellschaft für Urologie, Berlin, Germany.; Department of Urology and Pediatric Urology, University Hospital Erlangen, Erlangen, Germany.; Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany., Risk MC; Urology Section, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA., Lyon JA; Library Services, Children's Mercy Hospital, Kansas City, Missouri, USA.; Center for Evidence-Based Policy, Portland, Oregon, USA., Kunath F; UroEvidence@Deutsche Gesellschaft für Urologie, Berlin, Germany.; Medizinische Fakultät am Medizincampus Oberfranken, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.; Department of Urology and Pediatric Urology, Klinikum Bayreuth GmbH, Bayreuth, Germany.
المصدر: The Cochrane database of systematic reviews [Cochrane Database Syst Rev] 2024 Jun 07; Vol. 6. Cochrane AN: CD013773. Date of Electronic Publication: 2024 Jun 07.
نوع المنشور: Systematic Review; Journal Article; Meta-Analysis; Review
اللغة: English
بيانات الدورية: Publisher: Wiley Country of Publication: England NLM ID: 100909747 Publication Model: Electronic Cited Medium: Internet ISSN: 1469-493X (Electronic) Linking ISSN: 13616137 NLM ISO Abbreviation: Cochrane Database Syst Rev Subsets: MEDLINE
أسماء مطبوعة: Publication: 2004- : Chichester, West Sussex, England : Wiley
Original Publication: Oxford, U.K. ; Vista, CA : Update Software,
مواضيع طبية MeSH: Carcinoma, Renal Cell*/surgery , Carcinoma, Renal Cell*/mortality , Carcinoma, Renal Cell*/secondary , Nephrectomy*/methods , Kidney Neoplasms*/surgery , Kidney Neoplasms*/mortality , Kidney Neoplasms*/pathology , Randomized Controlled Trials as Topic* , Cytoreduction Surgical Procedures*/methods, Humans ; Quality of Life ; Antineoplastic Agents/therapeutic use ; Watchful Waiting ; Combined Modality Therapy/methods ; Disease Progression ; Cause of Death ; Bias
مستخلص: Background: Nephrectomy is the surgical removal of all or part of a kidney. When the aim of nephrectomy is to reduce tumor burden in people with established metastatic disease, the procedure is called cytoreductive nephrectomy (CN). CN is typically combined with systemic anticancer therapy (SACT). SACT can be initiated before or immediately after the operation or deferred until radiological signs of disease progression. The benefits and harms of CN are controversial.
Objectives: To assess the effects of cytoreductive nephrectomy combined with systemic anticancer therapy versus systemic anticancer therapy alone or watchful waiting in newly diagnosed metastatic renal cell carcinoma.
Search Methods: We performed a comprehensive search in the Cochrane Library, MEDLINE, Embase, Scopus, two trial registries, and other gray literature sources up to 1 March 2024. We applied no restrictions on publication language or status.
Selection Criteria: We included randomized controlled trials (RCTs) that evaluated SACT and CN versus SACT alone or watchful waiting.
Data Collection and Analysis: Two review authors independently selected studies and extracted data. Primary outcomes were time to death from any cause and quality of life. Secondary outcomes were time to disease progression, treatment response, treatment-related mortality, discontinuation due to adverse events, and serious adverse events. We performed statistical analyses using a random-effects model. We rated the certainty of evidence using the GRADE approach.
Main Results: Our search identified 10 records of four unique RCTs that informed two comparisons. In this abstract, we focus on the results for the two primary outcomes. Cytoreductive nephrectomy plus systemic anticancer therapy versus systemic anticancer therapy alone Three RCTs informed this comparison. Due to the considerable heterogeneity when pooling across these studies, we decided to present the results of the prespecified subgroup analysis by type of systemic agent. Cytoreductive nephrectomy plus interferon immunotherapy versus interferon immunotherapy alone CN plus interferon immunotherapy compared with interferon immunotherapy alone probably increases time to death from any cause (hazard ratio [HR] 0.68, 95% confidence interval [CI] 0.51 to 0.89; I²= 0%; 2 studies, 326 participants; moderate-certainty evidence). Assuming 820 all-cause deaths at two years' follow-up per 1000 people who receive interferon immunotherapy alone, the effect estimate corresponds to 132 fewer all-cause deaths (237 fewer to 37 fewer) per 1000 people who receive CN plus interferon immunotherapy. We found no evidence to assess quality of life. Cytoreductive nephrectomy plus tyrosine kinase inhibitor therapy versus tyrosine kinase inhibitor therapy alone We are very uncertain about the effect of CN plus tyrosine kinase inhibitor (TKI) therapy compared with TKI therapy alone on time to death from any cause (HR 1.11, 95% CI 0.90 to 1.37; 1 study, 450 participants; very low-certainty evidence). Assuming 574 all-cause deaths at two years' follow-up per 1000 people who receive TKI therapy alone, the effect estimate corresponds to 38 more all-cause deaths (38 fewer to 115 more) per 1000 people who receive CN plus TKI therapy. We found no evidence to assess quality of life. Immediate cytoreductive nephrectomy versus deferred cytoreductive nephrectomy One study evaluated CN followed by TKI therapy (immediate CN) versus three cycles of TKI therapy followed by CN (deferred CN). Immediate CN compared with deferred CN may decrease time to death from any cause (HR 1.63, 95% CI 1.05 to 2.53; 1 study, 99 participants; low-certainty evidence). Assuming 620 all-cause deaths at two years' follow-up per 1000 people who receive deferred CN, the effect estimate corresponds to 173 more all-cause deaths (18 more to 294 more) per 1000 people who receive immediate CN. We found no evidence to assess quality of life.
Authors' Conclusions: CN plus SACT in the form of interferon immunotherapy versus SACT in the form of interferon immunotherapy alone probably increases time to death from any cause. However, we are very uncertain about the effect of CN plus SACT in the form of TKI therapy versus SACT in the form of TKI therapy alone on time to death from any cause. Immediate CN versus deferred CN may decrease time to death from any cause. We found no quality of life data for any of these three comparisons. We also found no evidence to inform any other comparisons, in particular those involving newer immunotherapy agents (programmed death receptor 1 [PD-1]/programmed death ligand 1 [PD-L1] immune checkpoint inhibitors), which have become the backbone of SACT for metastatic renal cell carcinoma. There is an urgent need for RCTs that explore the role of CN in the context of contemporary forms of systemic immunotherapy.
(Copyright © 2024 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.)
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المشرفين على المادة: 0 (Antineoplastic Agents)
تواريخ الأحداث: Date Created: 20240607 Date Completed: 20240607 Latest Revision: 20240620
رمز التحديث: 20240620
مُعرف محوري في PubMed: PMC11157663
DOI: 10.1002/14651858.CD013773.pub2
PMID: 38847285
قاعدة البيانات: MEDLINE
الوصف
تدمد:1469-493X
DOI:10.1002/14651858.CD013773.pub2