Impact of Cytoreductive Nephrectomy and Systemic Therapy on Survival Outcomes Among Metastatic Non-Clear Cell Renal Cell Carcinoma

Document Type

Conference Proceeding

Publication Date

5-2026

Publication Title

Journal of Urology

Abstract

INTRODUCTION AND OBJECTIVES: Metastatic non-clear cell renal cell carcinoma (nccRCC) is a rare entity that includes a wide range of histologies. Although systemic therapies, including tyrosinekinase inhibitors and immune checkpoint inhibitors, have advanced the management of metastatic RCC, the impact of cytoreductive nephrectomy (CN) with systemic therapy (ST) on survival remains unclear. To understand this, we used the National Cancer Database to evaluate survival outcomes among patients with metastatic nccRCC who received ST and CN.METHODS: We included patients who were diagnosed with metastatic nccRCC (including sarcomatoid, papillary, chromophobe, and others) between 2004 and 2020. We stratified patients by treatment into the CN group, comprising patients with CN with or without ST, and the non-CN group, comprising patients who did not undergo CN. We used Kaplan-Meier survival analysis to evaluate overall survival (OS)between the two treatment arms. We then performed a multivariate Cox regression analysis that included age, sex, comorbidity index, facility type, tumor size, and histology to evaluate the survival hazards. RESULTS: A total of 2,753 patients were diagnosed with met-astatic nccRCC. Among them, those who underwent CN had 2-year and 5-year OS rates of 35.2% and 19.2%, respectively, compared to18.5% and 7.5% for patients who did not receive CN (p< 0.001).Among patients who received systemic therapy, the median OS at 6 and 12 months was 62.1% and 27.6%, respectively. Whereas among patients who did not receive ST, the median OS at 6 and 12 months was 32.9% and 16.9%, respectively (p< 0.05). Multivariate Cox regression analysis showed that patients receiving CN had a decreased risk of mortality (HR =0.46[0.41-0.53], p< 0.001). Similarly, patients who received ST had an 18% reduced risk of mortality compared to those who did not receive ST. CONCLUSIONS: In our study on metastatic nccRCC, we observed that CN with or without ST had improved OS, and patients who received ST had reduced mortality risk. In the evolving landscape of systemic and targeted therapies for metastatic nccRCC, the observed benefit of cytoreductive nephrectomy highlights its significant role in improving OS. Therefore, a multimodal approach combining CN with ST could improve OS in metastatic nccRCC.

Volume

215

Issue

5S

First Page

e1545

Comments

American Urological Association Annual Meeting, May 15-18, 2026, Washington, DC

Last Page

e1545

DOI

10.1097/01.JU.0001191748.13230.ac.09

Link to Full Text

Share

COinS