Nephrectomy followed by interferon alfa-2b compared with interferon alfa-2b alone for metastatic renal-cell cancer

Background: The value of nephrectomy in metastatic renal-cell cancer has lo ng been debated. Several nonrandomized studies suggest a higher rate of res ponse to systemic therapy and longer survival in patients who have undergon e nephrectomy. Methods: We randomly assigned patients with metastatic renal-cell cancer wh o were acceptable candidates for nephrectomy to undergo radical nephrectomy followed by therapy with interferon alfa-2b or to receive interferon alfa- 2b therapy alone. The primary end point was survival, and the secondary end point was a response of the tumor to treatment. Results: The median survival of 120 eligible patients assigned to surgery f ollowed by interferon was 11.1 months, and among the 121 eligible patients assigned to interferon alone it was 8.1 months (P=0.05). The difference in median survival between the two groups was independent of performance statu s, metastatic site, and the presence or absence of a measurable metastatic lesion. Conclusions: Nephrectomy followed by interferon therapy results in longer s urvival among patients with metastatic renal-cell cancer than does interfer on therapy alone. (N Engl J Med 2001;345:1655-9.) Copyright (C) 2001 Massac husetts Medical Society.