Survival benefits of Cytoreductive Nephrectomy in patients with metastatic renal cell carcinoma: evidence from a SEER-based retrospective cohort study

Abstract

Background Metastatic renal cell carcinoma (mRCC) is associated with poor prognosis, with a 5-year survival rate of less than 15%. Cytoreductive nephrectomy (CN) has historically played a critical role in mRCC management, potentially enhancing systemic therapy efficacy by reducing tumor burden. However, its relevance in the era of targeted therapies and immune checkpoint inhibitors (ICIs) has been questioned. Objective This study evaluates the survival benefits of CN in mRCC patients using real-world, population-based data from the SEER database. Methods A retrospective cohort analysis of 6,030 mRCC patients was performed using data from 2010 to 2017. Propensity score matching (PSM) minimized selection bias, yielding 1,350 matched patients. Kaplan-Meier survival curves and multivariate Cox proportional hazards models assessed the impact of CN on overall survival (OS) and RCC-specific survival (CSS), stratified by demographic and clinical characteristics. Results CN was associated with a 71% reduction in all-cause mortality (HR = 0.29, 95% CI = 0.25–0.33) and RCC-specific mortality (HR = 0.29, 95% CI = 0.25–0.34). Five-year OS rates were 31.5% in the CN group versus 3.6% in the non-CN group. Survival benefits were consistent across subgroups, including patients with high-grade or advanced-stage tumors, underscoring the role of CN within multimodal treatment strategies. Conclusion CN confers significant survival advantages in mRCC, even in challenging clinical scenarios. These findings reinforce the importance of integrating CN into multimodal therapeutic frameworks, particularly alongside modern systemic therapies. Further prospective studies are warranted to optimize patient selection and treatment sequencing.