Cancer - Kidney(구연) (E-083) Effect of Cytoreductive Nephrectomy According to First-line Tyrosine Kinase Inhibitor Treatment in Synchronous Metastatic Clear Cell Renal Cell Carcinoma: Sunitinib versus Pazopanib 계명대학교 동산병원, ¹경북대학교병원, ²영남대학교병원, ³대구가톨릭대학교병원, ⁴동국대학교 경주병원 신택준, 최민수, 김병훈, 김천일, 최석환¹, 김현태¹, 김태환¹, 권태균¹, 고영휘², 하윤수³, 박재신³, 권세윤⁴, 이경섭⁴ Objectives: There have been no reports on effect of cytoreductive nephrectomy (CN) between sunitinib and pazopanib as first-line tyrosine kinase inhibitor (TKI) treatment in synchronous metastatic clear cell renal cell carcinoma (ccRCC). We sought to analyze the prognostic outcome of CN between sunitinib and pazopanib in synchronous metastatic ccRCC. Materials and Methods: Data of 357 metastatic RCC patients who received the sunitinib or pazopanib as first-line TKI treatment from the Daekyung Oncology Study Group database was obtained and analyzed. Among these data, patients with synchronous and only clear cell type were included, and patients who underwent TKI treatment for less than 3 months were excluded. Results: Of 151 patients who met the inclusion criteria, Sunitinib and pazopanib group were identified in 99 (66 %) and 52 (34 %) patients, respectively. There was no significant difference in IMDC risk and comorbidities between two groups. But Sunitinib group was younger (59 vs. 65 yr, p=0.005). In sunitinib group, patients who underwent CN were 58 % (n=57). There was no significant difference in disease control rate (DCR, 90 vs. 93 %, p=0.718) and the median progression-free survival (PFS, 5 vs. 13 mo, p=0.125) between no CN and CN, but the median overall survival (OS) was longer (9 vs. 29 mo, p<0.001). In multivariate analysis, IMDC risk group and CN were significant prognostic factors for OS (poor IMDC vs. favorable, HR: 208; 95% CI, 5.-7646; p=0.004, CN vs. no CN, HR: 0.25; 95% CI, 0.08-0.78, p=0.017). In pazopanib group, patients who underwent CN were 52 % (n=27). However, there was no significant difference in DCR (92 vs. 88 %, p=1.000), the median PFS (6 vs. 9 mo, p=0.603) and OS (11 vs. 25 mo, p=0.246) between no CN and CN. In sub-analysis of favorable risk group underwent CN (n=36), there was no significant difference in age and comorbidities between sunitinib and pazopanib. But sunitinib group showed a longer median OS compared to pazopanib (23 vs. 29 mo, p=0.011) Conclusions: In synchronous metastatic ccRCC, CN had a better OS in patients who received sunitinib as first-line TKI treatment compared to those who received pazopanib. CN and sunitinib treatment may be advisable in patients with synchronous metastatic ccRCC who are able to provide active treatment. keywords : metastatic RCC, cytoreductive nephrectomy, TKI