Cytoreduction Nephrectomy in Metastatic Renal Cancer: The Results of Southwest Oncology Group Trial 8949

James Metz, MD
OncoLink Associate Editor
Last Modified: May 22, 2000

Presenter: Robert Charles Flanigan
Affiliation: Southwest Oncology Group

Metastatic renal cancer has a poor prognisis and is classically highly resistant to chemotherapy. A number of case series have reported a benefit to neprhectomy in patients with metastatic renal cancer. This prospective randomized trial was designed to determine whether nephrectomy prior to systemic therapy with interferon prolongs survival

Materials and Methods:

  • 246 patients with operable metstatic renal carcinoma and SWOG performance status 0 - 1 were randomized to one of two arms: 1. Neprhectomy plus alpha interferon 2. Alpha interferon without nephrectomy.

  • Interferon 5 Million Units was administered Q M- W-F and continued until progression.

  • The study was well balanced between arms for age, gender and race. However, there were more patients with better performance status in the nephrectomy arm.

  • Median survival was 12.5 months vs. 8.1 months in favor of the nephrectomy group (p = 0.006)

  • The 1-year actuarial survival was 50% vs. 37%, again in favor of nephrectomy.

  • There was a poor response rate from interferon in both arms (3% in both arms)
Authors' Conclusions

  • There is a clear survival advantage to nephrectomy prior to biologic therapy based on the results of this trial.

  • This represents a new algorithm for the management of metastatic renal call carcinoma in patients with good performance status
Clinical/Scientific Implications:

  • This study shows a greater than 50% improvement in survival for patients with metastatic disease who undergo neprhrectomy.

  • The performance status can have a great imact on survival, and the imbalance between the two arms of this trial may have contributed to the differences in outcome.

  • Fortunately, a recent EORTC trial with similar design (presented last month at the American Urologic Association meeting) showed a survival advantage also in favor of nephrectomy.

  • Based on these two trials, surgery can be considered in select patients with good performance status when they present with metastatic disease.

  • Further evaluation of appropriate systemic therapy is warranted.