尽管减瘤性肾切除术 (CN) 在转移性肾细胞癌 (mRCC) 中的作用已得到证实，但其最佳时机尚不清楚。本系统评价的目的是比较前期 (uCN) 和延迟 (dCN) CN 之间的总生存期 (OS)。查询了 MEDLINE、EMBASE 和 Web of Science 数据库（检索结束日期：2023 年 8 月 26 日）用于比较 mRCC 患者 uCN 和 dCN 之间的 OS 的研究。我们根据已发表的 Kaplan-Meier 生存曲线重建了个体患者数据，并进行了一阶段和两阶段荟萃分析，使用 6 个月和 12 个月的里程碑来减轻不朽的时间偏差。我们还根据全身治疗 (ST) 类型和纪念斯隆凯特琳癌症中心 (MSKCC)/国际转移性肾细胞癌数据库联盟 (IMDC) 风险评分进行亚组分析。我们使用干预措施的非随机研究中的偏倚风险和偏倚风险 2.0 工具评估了偏倚风险。我们确定了 12 项（两项随机试验和 10 个回顾性队列）符合条件的研究，总共 3323 项（2610 个 uCN 和 713 个 dCN） ） 患者。除转移灶数量和 ST 类型外，两组基线特征无统计学差异。 12 项研究中有 9 项的总体偏倚风险较高。在主要分析中，延迟 CN 与较高的 OS 相关（风险比 [HR] 0.74，95% 置信区间 [CI] 0.65-0.84；5 年预期寿命差异 5.15 个月，95% CI 3.23-7.08），所有二次分析，以及酪氨酸激酶抑制剂治疗（HR 0.61，95% CI 0.51-0.74）、免疫检查点抑制剂治疗（HR 0.67，95% CI 0.46-0.97）和中等 IMDC/MSKCC 风险（HR 0.73，95） % CI 0.55-0.97）亚组。在接受当代 ST 治疗的 mRCC 患者中，与 uCN 相比，延迟 CN 与更高的 OS 相关。有必要进行随机研究来证实这些发现。需要预测模型来优化最有可能从 dCN 受益的患者的选择。在本报告中，我们比较了转移性肾癌患者开始全身治疗之前（预先）或之后（推迟）进行的肾切除术的结果。我们发现，无论采用何种全身治疗方案，与前期肾切除术相比，延迟肾切除术具有更高的生存率。版权所有 © 2024 欧洲泌尿外科协会。由 Elsevier B.V. 出版。保留所有权利。

Despite its well-established role in metastatic renal cell carcinoma (mRCC), the optimal timing of cytoreductive nephrectomy (CN) is unclear. The aim of this systematic review is to compare the overall survival (OS) between upfront (uCN) and deferred (dCN) CN.The MEDLINE, EMBASE, and Web of Science databases were queried (end of search date: August 26, 2023) for studies comparing OS between uCN and dCN in mRCC patients. We reconstructed individual patient data from published Kaplan-Meier survival curves and performed one- and two-stage meta-analyses, using 6- and 12-mo landmarks to mitigate immortal time bias. We also performed subgroup analyses according to systemic therapy (ST) type and Memorial Sloan Kettering Cancer Center (MSKCC)/International Metastatic RCC Database Consortium (IMDC) risk scores. We assessed the risk of bias using the Risk of Bias in Non-randomized Studies of Interventions and Risk of Bias 2.0 tools.We identified 12 (two randomized trials and ten retrospective cohorts) eligible studies with a total of 3323 (2610 uCN and 713 dCN) patients. There were no statistically significant differences in the baseline characteristics of the two groups, other than the number of metastases and ST type. The overall risk of bias was high in nine out of 12 studies. Deferred CN was associated with superior OS in the primary analysis (hazard ratio [HR] 0.74, 95% confidence interval [CI] 0.65-0.84; 5-yr life expectancy difference 5.15 mo, 95% CI 3.23-7.08), all secondary analyses, as well as the tyrosine kinase inhibitor-treated (HR 0.61, 95% CI 0.51-0.74), immune checkpoint inhibitor-treated (HR 0.67, 95% CI 0.46-0.97), and intermediate IMDC/MSKCC risk (HR 0.73, 95% CI 0.55-0.97) subgroups.Deferred CN is associated with superior OS compared with uCN in mRCC patients treated with contemporary STs. Randomized studies are warranted to confirm these findings. Predictive models are needed to optimize the selection of patients most likely to benefit from dCN.In this report, we compared the outcomes of nephrectomy performed before (upfront) or after (deferred) starting systemic therapy for patients with metastatic kidney cancer. We found that deferred nephrectomy is associated with superior survival compared with upfront nephrectomy, irrespective of the systemic therapy regimens used.Copyright © 2024 European Association of Urology. Published by Elsevier B.V. All rights reserved.