免疫檢查點抑制劑合併酪胺酸激酶抑制劑治療後進行延後性細胞減除性腎臟切除術於轉移性透明細胞型腎細胞癌之可行性與治療結果

徐震翰¹、張延驊¹、魏子鈞¹、黃子豪¹、黃逸修¹、

台北榮民總醫院泌尿部¹

Feasibility and Outcomes of Deferred Cytoreductive Nephrectomy Following Immune Checkpoint Inhibitor Plus Tyrosine Kinase Inhibitor Therapy in Metastatic Clear Cell Renal Cell Carcinoma

Chen-Han Hsu¹, Yen-Hwa Chang¹, Tzu-Chun Wei¹, Tzu-Hao Huang¹, 

Eric Yi-Hsiu Huang¹

Department of Urology, Taipei Veterans General Hospital¹

Introduction:

The role of cytoreductive nephrectomy (CN) in the era of immune checkpoint inhibitor (ICI)–based combination therapy for metastatic clear cell renal cell carcinoma (mccRCC) remains under investigation. With the emergence of ICI plus VEGFR tyrosine kinase inhibitor (TKI) regimens as standard first-line therapy, deferred CN after systemic disease control has become an area of growing clinical interest. We report real-world perioperative and early survival outcomes of patients undergoing deferred CN following ICI + TKI therapy at a tertiary referral center.

Materials and Methods:

We retrospectively reviewed adult patients with mccRCC who received first-line ICI + TKI therapy followed by CN between 2019 and 2025. Baseline characteristics included age, sex, ECOG performance status, IMDC risk, and metastatic burden/sites. Primary endpoints were perioperative outcomes and pathological response. Secondary endpoints included progression-free survival (PFS) and overall survival (OS), estimated using the Kaplan-Meier method.

Results:

A total of 23 patients were included. All received ICI + TKI combination therapy before CN: 10 (43%) received nivolumab + cabozantinib, 8 (35%) pembrolizumab + axitinib, and 5 (22%) pembrolizumab plus lenvatinib. The median age was 61 years; 66% were male, and 76% had intermediate IMDC risk. Pathologic complete response (pCR) was observed in 5 patients (21%), and radiologic or pathologic downstaging occurred in 15 patients (65%). Postoperative complications were manageable, and no perioperative mortality occurred.

Conclusions:

Deferred CN following ICI + TKI therapy was feasible and safe, achieving substantial radiologic and pathologic responses with encouraging disease control. These findings support the role of consolidative CN in carefully selected patients who demonstrate

favorable response to first-line systemic therapy.