延期减量肾切除术对晚期肾细胞癌患者生存的影响：一项系统回顾和荟萃分析

IF 2.4 3区医学 Q2 UROLOGY & NEPHROLOGY

Asian Journal of Urology Pub Date : 2025-04-01 DOI:10.1016/j.ajur.2024.06.003

Mohammad Taufiq Alamsyah , Fauriski Febrian Prapiska , Syah Mirsya Warli

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引用次数: 0

摘要

目的IV期肾细胞癌（RCC）与生存率显著降低相关。细胞减减性肾切除术（CN）是IV期肾细胞癌的治疗方法之一。然而，有研究表明，延迟的CN可能对患者的生存有好处。我们的目的是研究延迟CN对晚期RCC患者生存与靶向治疗序贯管理（TT）的影响。方法在PubMed、EMBASE、EBSCOhost、MedRxiv、Scopus中进行文献检索。我们纳入了随机临床试验和非随机干预研究，比较接受TT治疗的晚期RCC患者的前期CN与延期CN的总生存期（OS）。meta分析采用Review Manager v5.4软件进行。固定效应和随机效应模型使用风险比和标准误差获得合并估计，使用森林图表示，置信区间为95%。结果对4项研究进行了定量分析。我们的分析显示，与那些接受前期TT后延期CN的患者相比，接受前期CN后TT的患者的OS显著改善（风险比0.50,95%可信区间0.40-0.64,p<0.001）。结论：研究结果表明，考虑早期TT后延迟CN可能会改善晚期RCC患者的OS。然而，需要更多的研究来充分了解TT和CN在晚期RCC治疗中的作用、最佳时机和测序。

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The impact of deferred cytoreductive nephrectomy on survival in advanced renal cell carcinoma: A systematic review and meta-analysis

Objective

Stage IV renal cell carcinoma (RCC) is associated with a significant decrease in survival rates. Cytoreductive nephrectomy (CN) is one of the treatments for stage IV RCC. However, there are studies showing that delayed CN might have benefits for the survival of the patients. We aimed to examine the impact of deferred CN on the survival of patients with advanced RCC in relation to sequential management with targeted therapy (TT).

Methods

A literature search was conducted in PubMed, EMBASE, EBSCOhost, MedRxiv, and Scopus. We included the randomized clinical trial and non-randomized study of intervention comparing the overall survival (OS) of upfront CN with deferred CN in patients with advanced RCC undergoing TT. Meta-analysis was carried out using Review Manager v5.4 software. The fixed-effect and random-effects models were used to obtain pooled estimates using the hazard ratio and standard error, presented using the forest plot with 95% confidence interval.

Results

Four studies were analyzed quantitatively. Our analysis revealed that patients with upfront TT followed by deferred CN had significantly improved OS compared to those who underwent upfront CN followed by TT (hazard ratio 0.50, 95% confidence interval 0.40–0.64, p<0.001).

Conclusion

The findings of the study suggest that considering upfront TT followed by deferred CN may lead to improved OS in patients with advanced RCC. However, more research is needed to fully understand the role, optimal timing, and sequencing of TT and CN in the treatment of advanced RCC.

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来源期刊

Asian Journal of Urology UROLOGY & NEPHROLOGY-

CiteScore

4.00

自引率

3.80%

发文量

100

审稿时长

4 weeks

期刊介绍： Asian Journal of Urology (AJUR), launched in October 2014, is an international peer-reviewed Open Access journal jointly founded by Shanghai Association for Science and Technology (SAST) and Second Military Medical University (SMMU). AJUR aims to build a communication platform for international researchers to effectively share scholarly achievements. It focuses on all specialties of urology both scientifically and clinically, with article types widely covering editorials, opinions, perspectives, reviews and mini-reviews, original articles, cases reports, rapid communications, and letters, etc. Fields of particular interest to the journal including, but not limited to: • Surgical oncology • Endourology • Calculi • Female urology • Erectile dysfunction • Infertility • Pediatric urology • Renal transplantation • Reconstructive surgery • Radiology • Pathology • Neurourology.