PURPOSE Metastatic renal cell carcinoma (mRCC) represents a significant and rising burden of disease, with rapidly evolving treatment modalities. The role of cytoreductive nephrectomy (CN) is controversial in this setting. As such, London Cancer has pursued a multidisciplinary team (MDT) approach when assessing suitability for surgery. METHODS A retrospective analysis of treatment-naive synchronous mRCC patients, managed via a renal-specialist MDT, was conducted between January 2015 and December 2018. An MDT selection algorithm for CN-using the International Metastatic Renal Cell Carcinoma Database Consortium score (IMDC), performance status and metastatic disease burden-was developed. RESULTS 87 treatment-naive synchronous mRCC patients received either CN (n = 18), Systemic therapy (ST) alone (n = 43) or Best supportive care (BSC) (n = 26). Progression free survival (PFS) and overall survival (OS) were assessed. 51% and 39% were IMDC intermediate and poor risk. Median PFS was 28.6 months and 4.5 months in the CN group and ST alone group, respectively, Hazard Ratio for death was 3.63 [(95% CI 1.68-7.83) p < 0.05]. OS remains immature for the CN group, but a median OS of 12.8 months was observed in the ST group and 5.0 months for BSC. 1-year OS rate for CN, ST and BSC groups was 77.8%, 55.8% and 23.10%, respectively. CONCLUSION These findings describe outcomes of an unselected series of patients treated via an MDT-driven, protocolised treatment pathway. MDT pathway-based decision making may improve patient selection for CN. Further research is needed to evaluate the role of CN amongst a growing landscape of treatment strategies, including immune checkpoint inhibitors and combination therapies. Multi-disciplinary team, pathway-based treatment strategy may improve patient selection for cytoreductive nephrectomy in patients with metastatic renal cell carcinoma.

中文翻译：

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转移性肾细胞癌的细胞减少性肾切除术：采用多学科算法驱动方法治疗的患者预后。

目的转移性肾细胞癌（mRCC）代表着重大且不断上升的疾病负担，其治疗方式正在迅速发展。在这种情况下，细胞减灭性肾切除术（CN）的作用引起争议。因此，伦敦癌症医院在评估手术的适用性时采用了多学科团队（MDT）的方法。方法回顾性分析2015年1月至2018年12月之间通过肾脏专科医生MDT治疗的未接受治疗的同步mRCC患者。采用国际转移性肾细胞癌数据库联盟评分（IMDC）的CN的MDT选择算法，表现状态和转移性疾病负担。结果87例未经治疗的同步mRCC患者接受了CN（n = 18），仅全身治疗（ST）（n = 43）或最佳支持治疗（BSC）（n = 26）。评估无进展生存期（PFS）和总生存期（OS）。51％和39％是IMDC中度和低风险。CN组和ST单独组中位PFS分别为28.6个月和4.5个月，死亡危险比为3.63 [（95％CI 1.68-7.83）p <0.05]。CN组的OS仍不成熟，但ST组的中位OS为12.8个月，BSC的中位OS为5.0个月。CN，ST和BSC组的1年OS率分别为77.8％，55.8％和23.10％。结论这些发现描述了一系列未经选择的患者的治疗结果，这些患者是通过MDT驱动的方案治疗途径治疗的。基于MDT途径的决策可以改善CN患者的选择。需要进一步研究以评估CN在日益增长的治疗策略中的作用，包括免疫检查点抑制剂和联合疗法。多学科团队，基于途径的治疗策略可能会改善转移性肾细胞癌患者的细胞减少性肾切除术的患者选择。