Metastasectomy Improves Overall Survival in Metastatic Renal Cell Carcinoma: A Retrospective Cohort Study

Background/Aim: The use of complete metastasectomy for treating metastatic renal cell carcinoma (mRCC) has been shown to improve survival outcomes in the era of tyrosine kinase inhibitors (TKIs). However, its effectiveness in combination with immune checkpoint inhibitors (ICIs) remains unclear. Therefore, the objective of the study was to elucidate the impact of metastasectomy in patients with mRCC who received both TKIs or ICIs. Patients and Methods: A total of 157 patients diagnosed with metastatic renal cell carcinoma (mRCC) between 2006 and 2018 in Taichung Veterans General Hospital were included in the study. Patients were divided into two groups: the non-metastasectomy group (n=89) and the metastasectomy group (n=68). Kaplan-Meier analyses and Cox proportional hazards models were employed to evaluate the impact of metastasectomy and other risk factors on overall survival (OS). Results: Among patients who underwent metastasectomy, 62 patients (91.18%) underwent metastasectomy for more than 50% of their metastatic sites, and 42 patients (61.76%) received complete metastasectomy. The median overall survival was 55.75 months in the metastasectomy group, which was significantly longer than the 15.14 months observed in the non-metastasectomy group (p<0.001). Multivariate regression analysis revealed that metastasectomy had a significant impact on overall survival [hazard ratio (HR)=0.42, 95% confidence interval (CI)=0.26-0.67, p<0.001]. Additionally, performance status and lactate dehydrogenase were identified as independent predictors for overall survival. Conclusion: Combination of metastasectomy with systemic therapy was shown to improve overall survival in patients with mRCC. Therefore, this modality may be considered as a viable option for patients who are fit for surgical intervention and are undergoing treatment with either TKIs or ICIs.