← BackRenal Cell Carcinoma · Surgical Oncology · Metastatic
SURTIME
In synchronous metastatic clear-cell RCC receiving sunitinib, does deferred cytoreductive nephrectomy after initial systemic therapy improve outcomes?
Population99 randomized patients with metastatic clear-cell RCC.InterventionThree cycles of sunitinib, then nephrectomy if no progression, followed by sunitinib.ComparatorImmediate nephrectomy followed by sunitinib.Primary clinical outcome28-week progression-free rate.Absolute Effect
The 28-week progression-free rate was 43% vs 42%, only +1 percentage point (P=.61). The trial was closed early for poor accrual and was underpowered for its original PFS endpoint.
Median OS was 32.4 vs 15.0 months and ITT OS HR was 0.57, but median survival is not converted into an NNT.
Clinical interpretation
Initial sunitinib can function as a biological selection step: patients progressing before planned surgery can avoid an operation unlikely to help. The OS signal is hypothesis-generating because the study was small and underpowered.
Current-practice context · reviewed 14 October 2026
SURTIME supports a systemic-therapy-first approach as a way to identify patients with rapidly progressive disease who may not benefit from cytoreductive nephrectomy. It was underpowered for its original primary endpoint and used sunitinib, so its sequencing result should not be treated as a direct comparison of immediate versus deferred surgery with today's immune-checkpoint inhibitor combinations. Current nephrectomy decisions are selective and depend on systemic-treatment response, symptoms, resectability, IMDC risk and multidisciplinary assessment.
SURTIME randomized trial, JAMA Oncology ↗ · EAU RCC disease-management guidance ↗