Impact Of Cytoreductive Nephrectomy On The Prognosis Of Renal Cell Carcinoma Patients With Liver Metastasis

Background:Despite the recent advances in the treatment of metastatic renal cell carcinoma(mRCC),the prognosis of mRCC is still poor.Cytoreductive nephrectomy(CN)refers to the removal of the primary renal tumor in the setting of mRCC.Liver is a common site of metastatic spread in patients with renal cell carcinoma(RCC).It is widely accepted that RCC with liver metastasis(LM)carries a dismal prognosis.Prior studies have begun to explore the effect of CN on the prognosis of mRCC patients but few of them evaluating the prognostic value of CN in RCCLM.One of the major limitations of previous studies could be considered the relatively small number of RCCLM in single-center studies,which could be solved by using open access databases.Objectives:1.To explore the research hotspots and development trends in the field of CN,and to provide reference for subsequent related research.2.We aimed to explore the value of CN among RCCLM based on population-based data.Methods:1.The relevant literature data in the field of CN research were obtained from the Web of Science database.VOSviewer software was used to conduct bibliometrics analysis and visualization.2.Patients’ characteristics were extracted from the Surveillance,Epidemiology,and End Results(SEER)database between 2010 and 2017.The univariate and multivariate Cox proportional hazard models were conducted to select the prognostic predictors of survival.Patients were divided into nephrectomy group and non-nephrectomy groups based on whether they underwent CN.Propensity score-matching(PSM)analyses were applied to reduce bias due to confounding variables between the groups.The primary endpoint was overall survival,which was determined using the Kaplan-Meier analyses and compared using the log-rank test.Results:1.A total of 608 articles were included,and the analysis found that the number of articles published in the United States,the total number of citations,and the strength of links were all ranked first in the world.The total number of published articles in China ranked 10th,and the number of citations ranked 21 st.According to keyword cooccurrence analysis,CN research can be divided into the following four categories:surgical treatment,prognosis,cytokine therapy,targeted and immunotherapy.The combination of CN and immunotherapy is the current research hotspot in this field.2.Data from 683 patients was extracted from the database.Univariate Cox regression and multivariate Cox regression revealed that factors including age,histologic type,T and N stages,lung metastasis,brain metastasis,and nephrectomy were significant predictors of survival in RCCLM patients.After PSM analyses,we found that overall survival was better for nephrectomy group compared with non-nephrectomy group(P<0.0001).Conclusions:1.America occupied a leading position in the field of CN research;the number and quality of related research in our country need to be further improved.The combination of CN and systemic treatment has been one of the research hotspots in this field.2.Cytoreductive nephrectomy can prolong overall survival in eligible renal cell carcinoma patients with liver metastasis.