Irem BILGETEKIN, Erdem OZTURK, Cengiz KARACIN, Fatma Bugdayci BASAL, Zeynep AKDAGCIK, Berna OKSUZOGLU
İstanbul Kuzey Klinikleri Dergisi - 2026;13(2):179-184
OBJECTIVE: The role of cytoreductive nephrectomy (CN) in metastatic renal cell carcinoma (RCC) is controversial. The aim of this study was to compare survival outcomes between nephrectomy and non-nephrectomy groups in patients with de novo metastatic renal cell carcinoma receiving tyrosine kinase inhibitors (TKI). METHODS: This retrospective study included 99 patients with de novo metastatic renal cell carcinoma, stratified according to receipt of cytoreductive nephrectomy. Baseline clinicopathological variables, including International Metastatic RCC Database Consortium (IMDC) risk category, Eastern Cooperative Oncology Group (ECOG) performance status, sarcomatoid features, Fuhrman grade, and TKI regimen, were collected. Overall survival was evaluated using Kaplan-Meier analysis. RESULTS: Among 99 patients, IMDC risk categories were favorable in 21 (21.2%), intermediate in 52 (52.5%), and poor in 26 (26.3%). CN was performed in 67 patients (67.7%). Pazopanib and sunitinib were used in 50 (50.5%) and 49 (49.5%) patients, respectively. In comparison with the nephrectomy cohort, a greater percentage of patients in the non-nephrectomy cohort were classified as poor risk (37.5% vs. 20.8%, p=0.010). Overall survival differed significantly across IMDC risk groups (p=0.001). In the favorable-risk subgroup, median overall survival was longer with nephrectomy than without surgery (42 vs. 12 months, p=0.042). There was no significant difference in survival between pazopanib and sunitinib treatment (14 vs. 16 months, p=0.251). CONCLUSION: CN was associated with improved overall survival in the favorable-risk subgroup, whereas no significant survival difference was observed in intermediate- or poor-risk groups.
