Report of case series: Correlation between pathological and radiological evaluation and clinical course of three cases of metastatic renal cell carcinoma with cytoreductive nephrectomy after combined immuno‐oncology therapy

Abstract

Introduction The pathologic evaluation and clinical course of cytoreductive nephrectomy after combined immuno‐oncology therapy were reviewed to understand the benefits of cytoreductive nephrectomy. Case presentation Three patients with clear cell carcinoma underwent tumor biopsy before combined immuno‐oncology therapy. Case 1 was found to have a sarcomatoid component upon nephrectomy and continued with combined immuno‐oncology therapy. Case 2 discontinued combined immuno‐oncology therapy due to adverse events but maintained tumor shrinkage. The patient was found to have viable cells in most nephrectomy specimens but has had no recurrence after combined immuno‐oncology therapy was discontinued. In case 3, the residual tumor was deemed resectable with combined immuno‐oncology therapy, and nephrectomy and metastasectomy were performed. No viable cells were observed in either specimen, and the patient has had no recurrence. Conclusion Cytoreductive nephrectomy after combined immuno‐oncology therapy may be useful to allow pathologic evaluation of treatment and provide an indicator for subsequent treatment.

Keywords

• cytoreductive surgery
• immunotherapy
• nephrectomy
• renal cell carcinoma
• sarcomatoid