Objectives. To report the clinical characteristics, impact of cytoreductive nephrectomy and survival of patients in the setting of metastatic renal cell carcinoma (RCC) and planned salvage immunotherapy.
Methods. We conducted a retrospective review of CancerCare Manitoba Registry for patients with metastatic RCC who underwent nephrectomy as an adjunct to planned interferon-α therapy. The cohort consisted of 22 consecutive patients referred for treatment between 2000 and 2005. Disease-specific survival was estimated using the Kaplan-Meier method and Cox proportional hazard regression was used to predict prognostic variables.
Results. Median patient age was 55 years (range 42 - 79). Metastases were documented to lymph nodes in 21%, liver in 27%, lung in 68% and bone in 46%. Cytoreductive nephrectomy was accomplished by an open surgical approach in 18 patients, and laparoscopically in 4 patients. Perioperative complications were minor in 7 patient and major in 2 patients, including 1 death. Median hospital stay was 6 days (range 3 - 48). Only 11 patients ultimately receive salvage immunotherapy 13 to 297 days (median 77) postoperatively. Moderate adverse events were experience by most patients on immunotherapy. The response rate to interferon-α was only partial in 2 out of 11 candidates. Overall median survival was 7.6 ± 1.7 months. Multivariate analysis showed age to be the only predictor of survival (HR 1.085, p = 0.007).
Conclusions. Our study demonstrates that cytoreductive nephrectomy in the setting of metastatic RCC can be a morbid procedure if patients are not carefully selected before surgery. Although surgical morbidity did not appear to preclude the administration of systemic therapy, the institution of immunotherapy was inconsistent and the response rate to interferon-α was low.

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