@entity1 presenting with @entity1358 ( @entity1358 ) face a dismal prognosis, with a median survival time of only 6 to 12 months and a 2-year survival rate of 10% to 20%. @entity1358 is notoriously chemorefractory, and immunotherapy is associated with total response rates of less than 20% and complete response rates of less than 5%. Therefore, surgery has continued to play a prominent role in the management of @entity1 with metastatic @entity1358 . Recent randomized prospective trials suggest a survival advantage for cytoreductive nephrectomy, and some @entity1 with advanced @entity1358 may also achieve palliation. @entity1 with limited and resectable @entity3 should be considered for combined nephrectomy and metastasectomy. The other main option for @entity1 with advanced @entity1358 is systemic immunotherapy followed by assessment for surgical consolidation, but responses in the @entity5 are uncommon and results with this pathway have not been encouraging. @entity5 embolization can be a valuable palliative adjunct for some @entity1 with metastatic @entity1358 . Cytoreductive nephrectomy represents the most aggressive pathway for @entity1 with metastatic @entity1358 . Although cytoreductive nephrectomy can extend survival by approximately 50% for many @entity1 , it can be associated with morbidity and delay in administration of systemic therapy. Therefore, @entity1 selection, taking into account performance status and sites and @entity66 , which are well-established prognostic factors for @entity1 with metastatic @entity1358 , is of paramount importance in managing this challenging group of @entity1 .

Nephrectomy in XXXX .

@entity1 :: ('9606', 'Species') :: ['Patients', 'patients', 'patient'] @entity66 :: ('MESH:D004194', 'Disease') :: ['burden of disease'] @entity5 :: ('MESH:D009369', 'Disease') :: ['Tumor', 'primary tumor'] @entity1358 :: ('MESH:D002292', 'Disease') :: ['RCC', 'metastatic renal cell carcinoma'] @entity3 :: ('MESH:D009362', 'Disease') :: ['metastases']
@entity1358 :: (MESH:D002292,Disease) :: ['metastatic renal cell carcinoma']
