Investig Clin Urol.  2018 Jan;59(1):2-9. 10.4111/icu.2018.59.1.2.

Role of cytoreductive nephrectomy in the targeted therapy era: A systematic review and meta-analysis

• García-Perdomo HA
• Zapata-Copete JA
• Castillo-Cobaleda DF

• KMID: 2399258
• DOI: http://doi.org/10.4111/icu.2018.59.1.2

Abstract

PURPOSE
To determine the effectiveness and harm of cytoreductive nephrectomy versus no intervention in patients with metastatic renal carcinoma who undergo targeted therapy to improve overall survival.
MATERIALS AND METHODS
A search strategy was conducted in the MEDLINE, CENTRAL, Embase, HTA, DARE, NHS, and LILACS databases. Searches were also conducted for unpublished literature through references from relevant articles identified through the search, conferences, thesis databases, OpenGrey, Google Scholar, and clinicaltrials.gov, among others. Studies were included without language restrictions. The risk of bias assessment was made by using a modified Cochrane Collaboration tool. A meta-analysis of fixed effects was conducted. The expected outcomes were overall survival, quality of life, adverse effects, mortality, and progression- free survival. The measure of the effect was the hazard ratio (HR) with a 95% confidence interval (CI). The planned comparison was cytoreductive nephrectomy versus no intervention.
RESULTS
A total of 22,507 patients were found among seven studies. Seven studies were included in the qualitative analysis (eight publications) and five in the quantitative analysis for overall survival. One study reported progression-free survival and one reported targeted therapy toxicities. A low risk of bias was shown for most of the study items. The HR for overall survival was 0.58 (95% CI, 0.50 to 0.65) favoring cytoreductive nephrectomy compared with no intervention.
CONCLUSIONS
Cytoreductive nephrectomy is effective for improving overall survival in patients with metastatic renal carcinoma who undergo targeted therapy compared with no intervention.

Keyword

Carcinoma, renal cell; Meta-analysis; Molecular targeted therapy; Nephrectomy; Review

MeSH Terms

Bias (Epidemiology)
Carcinoma, Renal Cell
Congresses as Topic
Cooperative Behavior
Disease-Free Survival
Humans
Molecular Targeted Therapy
Mortality
Nephrectomy*
Quality of Life

Figure

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  Fig. 1 Flow chart of included studies.

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  Fig. 2 Meta-analysis of included studies for overall survival. HR, hazard ratio; CI, confidence interval.

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