%0 Journal Article
%T Current landscape of cytoreductive nephrectomy: who, when, and why?
%A Alfredo Harb-De la Rosa
%A Jiping Zeng
%A Juan Chipollini
%J SCIE-indexed Journal
%D 2019
%R 10.21037/atm.2019.04.03
%X The use of cytoreductive nephrectomy (CN) in the cytokine therapy era was well supported by two randomized controlled trials conducted by the Southwest Oncology Group and the European Organization for Research and Treatment of Cancer (1,2). However, due to the rapid advancement of novel therapies, the benefits of CN for metastatic renal cell carcinoma (mRCC) have been widely questioned. As CN remains a morbid procedure with perioperative death rate of 3每4% (3), the consensus is to offer surgery in only select patients. In order to better define survival benefit, Margulis et al. developed a predictive model of postoperative death after CN using single institutional data ranging from 1991 to 2008 including patients treated with cytokine therapy either preoperatively or postoperatively (4). This model attempted to predict 6-month postoperative death (PoD), which plays an important role in decision making for both patients and physicians. In a recent article published in the World Journal of Urology titled ※External validation of a predictive model of survival after cytoreductive nephrectomy for metastatic renal cell carcinoma§, Marconi et al. sought to externally validate this model by using multi-institutional data from European and North American centers in the targeted therapy era (5). Both pre- and postoperative models were well calibrated (AUC: 0.68, 95% CI: 0.62每0.74 and 0.73, 95% CI: 0.68每0.78; respectively) for predicting PoD following CN. A decision curve analysis was used to determine the clinical value of the model in the preoperative setting. The model performed well when CN was examined within threshold survival probabilities of 20每50%. The authors estimated the range of probability thresholds in a typical CN population as the probability of death at 6 months to be 20每40%. Thus, the model offers prognostic clinical value for patients and clinicians considering CN
%U http://atm.amegroups.com/article/view/25489/html