Knowledge of the horizon: a meta-analysis of evaluating mortality incidence in multiple modalities therapy for metastatic renal cell carcinoma

The treatment landscape for metastatic renal cell carcinoma (mRCC) has improved with advances in targeted therapy, immunotherapy, and surgical interventions, each showing survival benefits. Although these approaches, used singly or in combination, improve outcomes, the optimal strategy remains to be determined. Yet, limited comparisons across strategies create a need to identify the most effective treatments for mRCC patients. To address this, we conducted a meta-analysis to evaluate combined surgical, targeted, and systemic therapies for mRCC, focusing on survival and mortality risk. Our aim was to offer insights that could guide future treatment approaches and improve patient outcomes. This meta-analysis was performed based on the PRISMA guidelines. Statistical analysis for meta-analyses using dichotomous types. To analyse clinical studies reporting the use of combination therapy (surgery and systemic intervention) for evaluating mortality incidence in mRCC, a systematic search was performed using three electronic databases (PubMed, Science Direct, and Google Scholar). Ten years of studies, English full paper text, and original research retrospective study design were included. Statistical analyses using Review Manager Application 5.4.1 version. From 1019 studies, there are eleven studies were eligible in this meta-analysis and have a low risk of bias. Ten studies comprising 2644 patients were included in this study for qualitative and quantitative analysis. Ten studies report the use of Combination Therapy (surgery and systemic intervention) for evaluating mortality incidence in mRCC. Quantitative synthesis showed Combination intervention was associated with death incidence in metastatic events in renal cell carcinoma with odds ratio (OR) 1.46 (95% CI; 1.37-1,54; I2=98%, p value=<0,0001). Furthermore, this research is still found to be qualitatively controversial. Our review indicates that combination therapies for mRCC improve survival outcomes but entail complex mortality risks. Further research is needed to refine therapy combinations and patient selection, underscoring a personalized approach to balance benefits with risks.