Oncological outcomes of deferred systemic therapy for patients with metastatic renal cell carcinoma: A systematic review and quantitative analysis

IF 2.8 3区医学 Q3 ONCOLOGY

Urologic Oncology-seminars and Original Investigations Pub Date : 2026-02-01 Epub Date: 2025-12-13 DOI:10.1016/j.urolonc.2025.11.008

Ichiro Tsuboi M.D. , Pawel Rajwa M.D. , Marcin Miszczyk M.D. , Tamás Fazekas M.D. , Akihiro Matsukawa M.D. , Mehdi Kardoust Parizi M.D. , Robert Schulz M.D. , Stefano Mancon M.D. , Ekaterina Laukhtina M.D. , Tatsushi Kawada M.D., Ph.D. , Satoshi Katayama M.D., Ph.D. , Takehiro Iwata M.D., Ph.D. , Kensuke Bekku M.D., Ph.D. , Koichiro Wada M.D., Ph.D. , Pierre I. Karakiewicz M.D., Ph.D. , Piotr Chlosta M.D., Ph.D. , Motoo Araki M.D., Ph.D. , Shahrokh F. Shariat M.D., Ph.D. , Riccardo Campi

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Abstract

Background and Objective

While some patients with metastatic renal cell carcinoma (mRCC) may experience an indolent disease progression and could benefit from deferred systemic therapy (ST), including active surveillance (AS) or metastasis-directed therapy (MDT), the evidence on its oncological efficacy and safety are still not well-established. We aimed to provide an overview of the available evidence on oncological outcomes of patients with mRCC undergoing deferred ST.

Methods

A systematic review of the literature was conducted in August 2024 using the PubMed, Scopus, and Embase databases to identify prospective and retrospective studies evaluating AS or deferred ST for patients with mRCC (PROSPERO ID: CRD42024579021). The co-primary outcomes were ST-free survival (ST-FS) and overall survival (OS). A random-effects model was used for quantitative analysis.

Key Findings and Limitations

We identified 15 eligible studies including 2,912 patients. Of these, 4 were prospective (n = 589 patients) and 11 were retrospective (n = 2,323 patients). The estimated 1-, 2-, 3-, 4-, and 5-year ST-FS rates (n = 1,070) were 74%, 54%, 49%, 43%, and 37%, respectively. The estimated 1-, 2-, 3-, 4-, and 5-year OS rates (n = 2,872) were 96%, 89%, 80%, 71%, and 69%, respectively. Key limitations at a study-level included selection bias, unmeasured confounding, and variability across deferred ST/AS protocols, including the indications for metastasis-directed therapy. Moreover, most studies used tyrosine kinase inhibitors as ST. The proportion of patients receiving MDT, including metastasectomy or stereotactic body radiation therapy, ranged from 14 to 100%.

Conclusions and Clinical Implications

Deferring ST by AS or MDT was associated with favorable oncological outcomes in carefully-selected patients with mRCC, highlighting the potential value of this approach in the contemporary multidisciplinary management of mRCC. Considering the limitations of available evidence and the lack of data on the oncological efficacy and safety of deferred ST for mRCC in the immune-oncology era, our review calls for further research in this field.

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转移性肾细胞癌患者延迟全身治疗的肿瘤预后：系统回顾和定量分析。

背景和目的：虽然一些转移性肾细胞癌（mRCC）患者可能经历惰性疾病进展，并可能受益于延迟全身治疗（ST），包括主动监测（AS）或转移导向治疗（MDT），但其肿瘤疗效和安全性的证据仍未得到证实。方法：我们于2024年8月使用PubMed、Scopus和Embase数据库对文献进行了系统回顾，以确定评估mRCC患者AS或延迟ST的前瞻性和回顾性研究（PROSPERO ID: CRD42024579021）。共同主要结局为无st生存期（ST-FS）和总生存期（OS）。采用随机效应模型进行定量分析。主要发现和局限性：我们确定了15项符合条件的研究，包括2,912名患者。其中4项为前瞻性研究（n = 589例），11项为回顾性研究（n = 2323例）。估计1年、2年、3年、4年和5年ST-FS率（n = 1,070）分别为74%、54%、49%、43%和37%。估计的1年、2年、3年、4年和5年OS率（n = 2,872）分别为96%、89%、80%、71%和69%。研究水平的主要限制包括选择偏倚、未测量的混杂因素和延迟ST/AS方案的可变性，包括转移导向治疗的适应症。此外，大多数研究使用酪氨酸激酶抑制剂作为st。接受MDT（包括转移切除术或立体定向全身放射治疗）的患者比例从14%到100%不等。结论和临床意义：在精心挑选的mRCC患者中，通过AS或MDT延迟ST与良好的肿瘤预后相关，突出了该方法在当代mRCC多学科管理中的潜在价值。考虑到现有证据的局限性以及在免疫肿瘤学时代延迟ST治疗mRCC的肿瘤疗效和安全性数据的缺乏，我们的综述呼吁在这一领域进行进一步的研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Urologic Oncology-seminars and Original Investigations 医学-泌尿学与肾脏学

CiteScore

4.80

自引率

3.70%

发文量

297

审稿时长

7.6 weeks

期刊介绍： Urologic Oncology: Seminars and Original Investigations is the official journal of the Society of Urologic Oncology. The journal publishes practical, timely, and relevant clinical and basic science research articles which address any aspect of urologic oncology. Each issue comprises original research, news and topics, survey articles providing short commentaries on other important articles in the urologic oncology literature, and reviews including an in-depth Seminar examining a specific clinical dilemma. The journal periodically publishes supplement issues devoted to areas of current interest to the urologic oncology community. Articles published are of interest to researchers and the clinicians involved in the practice of urologic oncology including urologists, oncologists, and radiologists.