Approximately 30% of patients with RCC present with stage IV disease. Two RANDOMIZED trials examined nephrectomy followed by interferon vs immediate THERAPY with interferon in patients presenting de novo with metastatic kidney cancer. Both trials showed significant trends TOWARD survival favoring nephrectomy before interferon. Therefore, in the cytokine era, cytoreductive nephrectomy before the institution of cytokine therapy became standard. Clinical trials in patients who have RECEIVED targeted therapy have required that patients have nephrectomy before enrollment, based largely on the cytokine results.

Approximately 30% of patients with RCC present with stage IV disease. Two randomized trials examined nephrectomy followed by interferon vs immediate therapy with interferon in patients presenting de novo with metastatic kidney cancer. Both trials showed significant trends toward survival favoring nephrectomy before interferon. Therefore, in the cytokine era, cytoreductive nephrectomy before the institution of cytokine therapy became standard. Clinical trials in patients who have received targeted therapy have required that patients have nephrectomy before enrollment, based largely on the cytokine results.