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Results of Cytoreductive Nephrectomy in Synchronous Metastatic Kidney Cancer and a Review of the Literature

Received: 15 May 2022    Accepted: 30 May 2022    Published: 20 July 2022
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Abstract

The management of synchronous metastatic renal cell carcinoma (mRCC) continues to be a therapeutic challenge. Surgery is a conceivable therapeutic option in the management of metastatic kidney cancer. The aim of our study is to clarify the interest and place of cytoreductive nephrectomy (NCR) in the treatment of mRCC, in the face of certain African realities where systemic treatment is rare and expensive. It was observational, retrospective, bi-centric study on a series of patients who underwent metastatic nephrectomy regardless of their prognostic group, between 2018 and 2020; monitored and treated jointly at the HIA OBO and at the ICL. Postoperative progression was defined by the appearance of new lesions or by the aggravation of pre-existing metastatic lesions. The primary endpoint of the study was survival without locoregional recurrence (LR), progression-free survival (PFS), the secondary endpoint was overall survival (OS). We collected 14 oligo metastatic patients, ECOG 0-1, the mean age was 50.64 years, with a sex ratio of 1.75. 57% of patients were T3-T4. There was a single metastatic site in 71.5%, 22%, 7.5%, pulmonary, hepatic, adrenal respectively. The patients were distributed according to Heng's prognosis group as follows: 64% patients with good, 22% patients with intermediate, 14% patients with poor prognosis. At 3 years, there was no LR, PFS was 78.57% and OS was 85.71%. 3 patients had received adjuvant treatment with sunitinib. And 5 patients, or 36%, had complete remission (CR). CRN remains a treatment option for metastatic kidney cancer, alone or associated with systemic treatment, in patients in good general condition. This CRN sometimes remains the only therapeutic option available in the absence of adjuvant treatment in our settings, even in the event of a poor prognosis in operable patients.

Published in World Journal of Medical Case Reports (Volume 3, Issue 3)
DOI 10.11648/j.wjmcr.20220303.11
Page(s) 38-42
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2022. Published by Science Publishing Group

Keywords

Renal Carcinoma, Metastatic, Nephrectomy

References
[1] Umbreit EC, McIntosh AG, Suk-Ouichai C, Karam JA, Wood CG. The current role of cytoreductive nephrectomy for metastatic renal cell carcinoma. Indian J Urol. 2021; 37 (1): 13-19.
[2] Silagy AW, Duzgol C, Marcon J, DiNatale RG, Mano R, Blum KA, Reznik E, Voss MH, Motzer RJ, Coleman JA, Russo P, Akin O, Hakimi AA. An evaluation of the role of tumor load in cytoreductive nephrectomy. Can Urol Assoc J. 2020 Dec; 14 (12): E625-E630.
[3] Silagy AW, Mano R, Blum KA, DiNatale RG, Marcon J, Tickoo SK, Reznik E, Coleman JA, Russo P, Hakimi AA. The Role of Cytoreductive Nephrectomy for Sarcomatoid Renal Cell Carcinoma: A 29-Year Institutional Experience. Urology. 2020 Feb; 136: 169-175.
[4] Rappold PM, Silagy AW, Kotecha RR, Hakimi AA. Immune checkpoint blockade in renal cell carcinoma. J Surg Oncol. 2021 Mar; 123 (3): 739-750.
[5] Nizam A, Schindelheim JA, Ornstein MC. The role of active surveillance and cytoreductive nephrectomy in metastatic renal cell carcinoma. Cancer Treat Res Commun. 2020 Feb 22; 23: 100169.
[6] Bell H, Cotta BH, Salami SS, Kim H, Vaishampayan U. "PROBE"ing the Role of Cytoreductive Nephrectomy in Advanced Renal Cancer. Kidney Cancer J. 2022 Mar 15; 6 (1): 3-9.
[7] Marcus SG, Choyke PL, Reiter R, Jaffe GS, Alexander RB, Linehan WM, et al. Regression of metastatic renal cell carcinoma after cytoreductive nephrectomy. J Urol. 1993; 150: 463–6.
[8] Garfield DH, Kennedy BJ. Regression of metastatic renal cell carcinoma following nephrectomy. Cancer. 1972; 30: 190–6.
[9] Bensalah K, Bigot P, Albiges L, Bernhard JC, Bodin T, Boissier R, Correas JM, Gimel P, Hetet JF, Long JA, Nouhaud FX, Ouzaïd I, Rioux-Leclercq N, Méjean A. Recommandations françaises du Comité de cancérologie de l’AFU – actualisation 2020–2022: prise en charge du cancer du rein [French ccAFU guidelines - update 2020-2022: management of kidney cancer]. Prog Urol. 2020 Nov; 30 (12S): S2-S51.
[10] Zhang Z, Wu H, Yang T, Wu Y, Yu N, Xu Z. Metastatic renal cell carcinoma patients of T4 stage who are in status of N1 stage or older than 76 years cannot benefit from cytoreductive nephrectomy. BMC Cancer. 2020 Sep 3; 20 (1): 844.
[11] Soares A, Maia MC, Vidigal F, Marques Monteiro FS. Cytoreductive Nephrectomy for Metastatic Renal Cell Carcinoma: How to Apply New Evidence in Clinical Practice. Oncology. 2020; 98 (1): 1-9.
[12] Tabakin AL, Stein MN, Anderson CB, Drake CG, Singer EA. Cytoreductive nephrectomy for metastatic renal cell carcinoma, the ultimate urologic 'Choosing Wisely' campaign: a narrative review. Transl Cancer Res. 2020 Nov; 9 (11): 7337-7349.
[13] Li C, Wang R, Ma W, Liu S, Yao X. Do Metastatic Kidney Cancer Patients Benefit from Cytoreductive Nephrectomy? A Real-World Retrospective Study from the SEER Database. Front Surg. 2021 Aug 30; 8: 716455.
[14] Woldu SL, Matulay JT, Clinton TN, et al. Incidence and Outcomes of Delayed Targeted Therapy After Cytoreductive Nephrectomy for Metastatic Renal-Cell Carcinoma: A Nationwide Cancer Registry Study. Clin Genitourin Cancer 2018.
[15] Iacovelli R, Galli L, De Giorgi U, et al. The effect of a treatment delay on outcome in metastatic renal cell carcinoma. Urol Oncol 2019; 37: 529.
[16] Guo B, Liu S, Wang M, Hou H, Liu M. The role of cytoreductive nephrectomy in renal cell carcinoma patients with liver metastasis. Bosn J of Basic Med Sci. 2021 Apr. 1 [cited 2022 Jan. 5]; 21 (2): 229-34.
[17] Larcher A, Wallis CJD, Bex A, Blute ML, Ficarra V, Mejean A, Karam JA, Van Poppel H, Pal SK. Individualised Indications for Cytoreductive Nephrectomy: Which Criteria Define the Optimal Candidates? Eur Urol Oncol. 2019 Jul; 2 (4): 365-378.
[18] Bex A, Mulders P, Jewett M, Wagstaff J, van Thienen JV, Blank CU, van Velthoven R, Del Pilar Laguna M, Wood L, van Melick HHE, Aarts MJ, Lattouf JB, Powles T, de Jong Md PhD IJ, Rottey S, Tombal B, Marreaud S, Collette S, Collette L, Haanen J. Comparison of Immediate vs Deferred Cytoreductive Nephrectomy in Patients with Synchronous Metastatic Renal Cell Carcinoma Receiving Sunitinib: The SURTIME Randomized Clinical Trial. JAMA Oncol. 2019 Feb 1; 5 (2): 164-170.
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    Smith Giscard Olagui, Mariette Nsa Bidzo, Jean Placide Owono Bouengou, Ernest Belembaogo. (2022). Results of Cytoreductive Nephrectomy in Synchronous Metastatic Kidney Cancer and a Review of the Literature. World Journal of Medical Case Reports, 3(3), 38-42. https://doi.org/10.11648/j.wjmcr.20220303.11

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    ACS Style

    Smith Giscard Olagui; Mariette Nsa Bidzo; Jean Placide Owono Bouengou; Ernest Belembaogo. Results of Cytoreductive Nephrectomy in Synchronous Metastatic Kidney Cancer and a Review of the Literature. World J. Med. Case Rep. 2022, 3(3), 38-42. doi: 10.11648/j.wjmcr.20220303.11

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    AMA Style

    Smith Giscard Olagui, Mariette Nsa Bidzo, Jean Placide Owono Bouengou, Ernest Belembaogo. Results of Cytoreductive Nephrectomy in Synchronous Metastatic Kidney Cancer and a Review of the Literature. World J Med Case Rep. 2022;3(3):38-42. doi: 10.11648/j.wjmcr.20220303.11

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  • @article{10.11648/j.wjmcr.20220303.11,
      author = {Smith Giscard Olagui and Mariette Nsa Bidzo and Jean Placide Owono Bouengou and Ernest Belembaogo},
      title = {Results of Cytoreductive Nephrectomy in Synchronous Metastatic Kidney Cancer and a Review of the Literature},
      journal = {World Journal of Medical Case Reports},
      volume = {3},
      number = {3},
      pages = {38-42},
      doi = {10.11648/j.wjmcr.20220303.11},
      url = {https://doi.org/10.11648/j.wjmcr.20220303.11},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.wjmcr.20220303.11},
      abstract = {The management of synchronous metastatic renal cell carcinoma (mRCC) continues to be a therapeutic challenge. Surgery is a conceivable therapeutic option in the management of metastatic kidney cancer. The aim of our study is to clarify the interest and place of cytoreductive nephrectomy (NCR) in the treatment of mRCC, in the face of certain African realities where systemic treatment is rare and expensive. It was observational, retrospective, bi-centric study on a series of patients who underwent metastatic nephrectomy regardless of their prognostic group, between 2018 and 2020; monitored and treated jointly at the HIA OBO and at the ICL. Postoperative progression was defined by the appearance of new lesions or by the aggravation of pre-existing metastatic lesions. The primary endpoint of the study was survival without locoregional recurrence (LR), progression-free survival (PFS), the secondary endpoint was overall survival (OS). We collected 14 oligo metastatic patients, ECOG 0-1, the mean age was 50.64 years, with a sex ratio of 1.75. 57% of patients were T3-T4. There was a single metastatic site in 71.5%, 22%, 7.5%, pulmonary, hepatic, adrenal respectively. The patients were distributed according to Heng's prognosis group as follows: 64% patients with good, 22% patients with intermediate, 14% patients with poor prognosis. At 3 years, there was no LR, PFS was 78.57% and OS was 85.71%. 3 patients had received adjuvant treatment with sunitinib. And 5 patients, or 36%, had complete remission (CR). CRN remains a treatment option for metastatic kidney cancer, alone or associated with systemic treatment, in patients in good general condition. This CRN sometimes remains the only therapeutic option available in the absence of adjuvant treatment in our settings, even in the event of a poor prognosis in operable patients.},
     year = {2022}
    }
    

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    AU  - Smith Giscard Olagui
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    AB  - The management of synchronous metastatic renal cell carcinoma (mRCC) continues to be a therapeutic challenge. Surgery is a conceivable therapeutic option in the management of metastatic kidney cancer. The aim of our study is to clarify the interest and place of cytoreductive nephrectomy (NCR) in the treatment of mRCC, in the face of certain African realities where systemic treatment is rare and expensive. It was observational, retrospective, bi-centric study on a series of patients who underwent metastatic nephrectomy regardless of their prognostic group, between 2018 and 2020; monitored and treated jointly at the HIA OBO and at the ICL. Postoperative progression was defined by the appearance of new lesions or by the aggravation of pre-existing metastatic lesions. The primary endpoint of the study was survival without locoregional recurrence (LR), progression-free survival (PFS), the secondary endpoint was overall survival (OS). We collected 14 oligo metastatic patients, ECOG 0-1, the mean age was 50.64 years, with a sex ratio of 1.75. 57% of patients were T3-T4. There was a single metastatic site in 71.5%, 22%, 7.5%, pulmonary, hepatic, adrenal respectively. The patients were distributed according to Heng's prognosis group as follows: 64% patients with good, 22% patients with intermediate, 14% patients with poor prognosis. At 3 years, there was no LR, PFS was 78.57% and OS was 85.71%. 3 patients had received adjuvant treatment with sunitinib. And 5 patients, or 36%, had complete remission (CR). CRN remains a treatment option for metastatic kidney cancer, alone or associated with systemic treatment, in patients in good general condition. This CRN sometimes remains the only therapeutic option available in the absence of adjuvant treatment in our settings, even in the event of a poor prognosis in operable patients.
    VL  - 3
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Author Information
  • Urology Department, Faculty of Medicine, University of Health Sciences, Libreville, Gabon

  • Urology Department, Faculty of Medicine, University of Health Sciences, Libreville, Gabon

  • General Surgery Department, Faculty of Medicine, University of Health Sciences, Libreville, Gabon

  • Oncology Department, Faculty of Medicine, University of Health Sciences, Libreville, Gabon

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