在联合免疫治疗时代，细胞减灭术（CN）的作用尚未得到很好的表征。根据以下标准评估接受基于免疫肿瘤学（IO）的联合治疗的转移性肾细胞癌（mRCC）患者的特征和结果CN 状态。使用国际 mRCC 数据库联盟 (IMDC)，纳入了接受一线 IO 联合治疗的 mRCC 患者。前期 CN 定义为转移性疾病诊断前 3 个月但全身治疗开始前的 CN。延迟 CN 定义为开始全身治疗后的 CN。从开始全身治疗起的总生存期 (OS) 通过 Cox 比例风险回归进行估计。使用 12 个月的标志时间和 CN 状态的时变协变量来减轻潜在的偏差。在符合标志分析条件的 385 名患者中，分别有 24 名、182 名和 179 名患者接受了延期 CN、预先 CN 和无 CN。无 CN 亚组中的患者年龄较大（延迟 CN 亚组中为 63 岁 vs 57 岁，预先 CN 亚组中为 60 岁；p = 0.001），并且骨转移比例较高（延迟 CN 亚组中为 44% vs 26%）前期 CN 亚组为 23%；p < 0.001）。前期 CN 亚组中 IMDC 风险较低的患者比例较低（无 CN 亚组为 23%，无 CN 亚组为 43%，延迟 CN 亚组为 47%；p < 0.001）。在多变量分析中，CN 收据是一个独立的有利预后因素（风险比 0.45，95% 置信区间 0.26-0.78；p = 0.005）。该研究因缺乏随机性及其回顾性而受到限制。尽管随着新型治疗药物的出现，实践模式发生了变化，CN 仍然可以作为精心挑选的患者的有效手术干预措施。对于转移性肾癌患者，手术治疗传统上，切除原发肿瘤是治疗的选择，但免疫治疗药物现在是这些患者的另一种选择。我们分析了接受联合免疫疗法作为首次治疗的当代转移性肾癌患者的数据。我们发现，在接受免疫治疗的选定患者中，手术切除原发肿瘤也可以带来更好的预后。版权所有 © 2023 欧洲泌尿外科协会。由 Elsevier B.V. 出版。保留所有权利。

The role of cytoreductive nephrectomy (CN) has not yet been well characterized in the era of combination immunotherapy.To evaluate characteristics and outcomes for patients with metastatic renal cell carcinoma (mRCC) who received immuno-oncology (IO)-based combination therapy according to CN status.Using the International mRCC Database Consortium (IMDC), patients with mRCC who received frontline IO-based combinations were included. Upfront CN was defined as CN up to 3 mo before diagnosis of metastatic disease but before systemic therapy initiation. Deferred CN was defined as CN after systemic therapy initiation.Overall survival (OS) from initiation of systemic therapy was estimated via Cox proportional-hazards regression. A 12-mo landmark time and a time-varying covariate for CN status were used to mitigate potential bias.Of the 385 patients eligible for landmark analysis, 24, 182, and 179 underwent deferred CN, upfront CN, and no CN, respectively. Patients in the no CN subgroup were older (63 yr vs 57 yr in the deferred CN subgroup and 60 yr in the upfront CN subgroup; p = 0.001) and a higher proportion had bone metastases (44% vs 26% in the deferred CN subgroup and 23% in the upfront CN subgroup; p < 0.001). A lower proportion of patients in the upfront CN subgroup had IMDC poor risk (23% vs 43% in the no CN subgroup and 47% in the deferred CN subgroup; p < 0.001). On multivariable analysis, CN receipt was an independent favorable prognostic factor (hazard ratio 0.45, 95% confidence interval 0.26-0.78; p = 0.005). The study is limited by the lack of randomization and its retrospective nature.Despite changes in practice patterns with the advent of novel therapeutic agents, CN may still serve as an effective surgical intervention in carefully selected patients.For patients with metastatic kidney cancer, surgery to remove the primary tumor was traditionally the treatment of choice, but immunotherapy drugs are now another option for these patients. We analyzed data for contemporary patients with metastatic kidney cancer who received combination immunotherapy as their first treatment. We found that in selected patients receiving immunotherapy, surgery to remove the primary tumor as well can result in better prognosis.Copyright © 2023 European Association of Urology. Published by Elsevier B.V. All rights reserved.