María Natalia Gandur Quiroga: Upfront vs. Deferred Cytoreductive Nephrectomy in mRCC

María Natalia Gandur Quiroga posted on X about recent paper by Stepan M. Esagian et al., titled “Upfront Versus Deferred Cytoreductive Nephrectomy in Metastatic Renal Cell Carcinoma: A Systematic Review and Individual Patient Data Meta-analysis” published on Science Direct.

Authors: Stepan M. Esagian, Jose A. Karam, Pavlos Msaouel, Dimitrios Makraki

“Upfront vs. Deferred Cytoreductive Nephrectomy in mRCC

Meta-analysis compared deferred CN (dCN) vs. upfront CN (uCN) in 3323 patients with metastatic RCC.
Key findings:

• dCN associated with superior overall survival (OS) (HR 0.74, 5-year life expectancy difference of 5.15 months).

• OS benefit observed with both TKI-treated patients (HR 0.61) and ICI-treated patients (HR 0.67).

• Intermediate-risk patients (IMDC/MSKCC) also benefited from dCN (HR 0.73).
dCN offers crucial prognostic value by assessing response to systemic therapy (ST) before surgery, allowing better selection of candidates.

Clinical Implications:

• Deferred CN helps avoid unnecessary surgery in patients who progress on ST.

• Early surgery could delay treatment; dCN ensures that all patients receive ST before nephrectomy, improving outcomes.

• Predictive models needed to better identify patients likely to benefit from dCN over upfront surgery.”

Source: María Natalia Gandur Quiroga/X

Maria Natalia Gandur Quiroga is a Medical Oncologist and Chief of the Division of Genitourinary Medical Oncology at the Ángel H. Roffo Oncology Institute in Buenos Aires, Argentina. She is a Professor of Medicine at the University of Buenos Aires at the Oncologists Post Graduates Studies. Her research focuses on clinical trials with aims to improve the treatment of patients with urologic tumors.  She is an active member of the European Association for Cancer Research, Argentinian Medical Association and American Society of Clinical Oncology.