Key messages
• People who have kidney removal surgery after receiving interferon immunotherapy (medicine that helps the immune system fight cancer) probably live longer than those who receive interferon immunotherapy without kidney removal surgery.
• People who have immediate kidney removal surgery then receive tyrosine kinase inhibitor therapy (medicine that identifies and attacks specific types of cancer cells) may live shorter than those who receive tyrosine kinase inhibitor therapy before kidney removal surgery.
• The quality of the included studies is limited, so we have little confidence in most of our findings.
What is metastatic renal cell carcinoma?
Renal cell carcinoma is a kind of cancer that starts in the kidneys. Metastatic means that the cancer has spread from the kidneys to other parts of the body.
What is cytoreductive nephrectomy?
Cytoreductive nephrectomy is a surgery to remove one of the kidneys that has cancer. ‘Cyto’ means cell, ‘reductive’ means to reduce, and ‘nephrectomy’ is a term for taking out a kidney. The aim of this surgery is to help get rid of some of the cancer cells and make other treatments more effective.
What did we want to find out?
Our review question was ‘How effective is kidney removal in combination with medicines for people with kidney cancer that has already spread to other parts of the body (outside the kidney) compared with only medicines?’ We were mainly interested in the effect of treatment on how long people lived and their quality of life.
What did we do?
We included only studies that allocated people to one of the treatment groups (cytoreductive nephrectomy plus medicine or medicine alone) at random. Most studies examined the effects of treatment on how long people lived.
What did we find?
We found four studies that answered our review question. People included in these studies had metastatic kidney cancer that could not be removed completely by surgery, but they were eligible for cytoreductive nephrectomy. We reported the evidence that is most important to doctors and patients.
We found that people who have cytoreductive nephrectomy after receiving interferon immunotherapy (medicine that helps the immune system fight cancer) probably live longer than people who receive interferon immunotherapy without cytoreductive nephrectomy. We are very uncertain about the effect of cytoreductive nephrectomy plus tyrosine kinase inhibitor (TKI) therapy (medicine that identifies and attacks specific types of cancer cells) compared with TKI therapy alone on survival. Lastly, immediate surgery followed by TKI therapy compared with delayed surgery after TKI therapy may worsen survival. We found no information on quality of life for any of these three comparisons.
We found no studies of surgery combined with newer immunotherapy medicines (called programmed death receptor 1/programmed death ligand 1 immune checkpoint inhibitors), which are now the main medicines used to treat people with metastatic renal cell carcinoma.
What are the limitations of the evidence?
We have little confidence in the evidence because the people in the studies were aware of which treatment they were getting, and because some results suggested cytoreductive nephrectomy could be either beneficial or harmful.
How up to date is this evidence?
The evidence is current to 1 March 2024.