J Urol Oncol.
2024 Mar;22(1):34-41. 10.22465/juo.244600140007.
Targeted Therapy Following Metastasectomy for Metastatic Renal Cell Carcinoma: A Systematic Review and Meta-analysis
- Affiliations
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- 1Department of Urology, Chonnam National University Medical School, Hwasun, Korea
- 2Yonsei Wonju Medical Library, Yonsei University Wonju College of Medicine, Wonju, Korea
- 3Department of Urology and Precision Medicine, Yonsei University, Wonju College of Medicine, Wonju, Korea
- 4Department of Medical Informatics and Biostatistics, Graduate School, Yonsei University, Seoul, Korea
- 5Department of Preventive Medicine, College of Medicine, Chosun University, Gwangju, Korea
- 6Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
- 7Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- 8Department of Urology, Ajou University School of Medicine, Suwon, Korea
- KMID: 2553943
- DOI: http://doi.org/10.22465/juo.244600140007
Abstract
- Purpose
The aim of this study was to assess the effects of tyrosine kinase inhibitors (TKIs) following metastasectomy in patients with metastatic renal cell carcinoma (mRCC).
Materials and Methods
A systematic search of multiple electronic databases was conducted. The inclusion criteria encompassed randomized clinical trials evaluating the use of TKIs after metastasectomy in mRCC patients. Study outcomes were relapse-free survival (RFS)/disease-free survival (DFS), overall survival (OS), and adverse events of TKIs.
Results
Two studies with 197 randomized participants that compared TKIs following metastasectomy versus metastasectomy alone were identified. According to these studies, TKIs following metastasectomy may result in little to no difference in RFS/DFS (hazard ratio [HR], 1.01; 95% confidence interval [CI], 0.65–1.57; I2=29%; low-certainty evidence). TKIs after metastasectomy may slightly increase OS, but the CI crossed the line of no effect (HR, 0.80; 95% CI, 0.06–9.87; I2=86%; low-certainty evidence). TKIs after metastasectomy likely resulted in a large increase in adverse events (risk ratio, 2.76; 95% CI: 1.65–4.62; I2=not applicable; moderatecertainty evidence).
Conclusions
TKIs following metastasectomy did not improve RFS/DFS, but slightly improved OS. It is likely that TKIs following metastasectomy increase adverse events compared to surgery only. The certainty of evidence ranged from moderate (signaling confidence that the reported effect size is likely close to the true effect) to low (indicating that the true effect may be substantially different from the effect estimate). The findings of this study should help to inform future guidelines and clinical decision-making at the point of care.
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