Background: lmmunotherapy is changing the treatment of patients with metastatic renal cell carcinoma (mRCC). In recent years, many immune checkpoint inhibitors (ICls) have been introduced, and ICl-combination therapies have changed the treatment landscape for patients with mRCC. However, the role of cytoreductive nephrectomy (CN) in patients with mRCC receiving ICls is not clear. We aimed to assess the role of ICl-combination therapies in patients receiving /not receiving CN. Methods: PubMed, Embase, and Cochrane Library databases were searched for English-language clinical trials, cohort studies, and case-control studies evaluating OS in patients with mRCC who underwent /did not undergo CN (end-of-search date: 1 April 2023). The hazard ratio [HR] and 95% confidence interval [CI] for OS obtained by multivariate analysis were extracted and aggregated. Meta-analysis was performed using Review manager 5.4.1, and p<0.05 was defined as a statistical significance. Results: Eleven studies met the eligibility criteria. Receiving CN+ICI combination therapy was associated with significantly better OS than patients receiving ICI combination therapy alone (HR: 0.56，95% CI: 0.46-0.69, P < 0.001). In subgroup analyses, thinking about the number of lines for immunotherapy, CN provided OS benefit when immunotherapy was used as either first-line (HR: 0.54, 95% CI: 0.41-0.70, P < 0.001) or non-first-line treatment (HR: 0.59, 95% CI: 0.44-0.81, P = 0.001). In terms of tumor pathologic type, CN also provided OS benefit no matter the pathologic type was only clear cell renal cell carcinoma (ccRCC) (HR: 0.52, 95% CI: 0.28-0.95, P = 0.03) or not (HR: 0.54, 95% CI: 0.39-0.75, P < 0.001). For the choice of drugs, CN provided OS benefits with nivolumab/nivolumab + ipilimumab (HR: 0.50, 95% CI: 0.32-0.79, P = 0.003) or immunotherapy combined with tyrosine kinase inhibitors (HR: 0.59, 95% CI: 0.48-0.73, P < 0.001). About the timing of CN, CN also provided OS benefit when performing before immunotherapy (HR: 0.63, 95% CI: 0.54-0.73, P < 0.001) or no strictly restricted (HR: 0.49, 95% CI: 0.33-0.74, P = 0.0007). Conclusions: CN brings good effect on OS in mRCC patients treated with ICI-combination therapies. In ICI-combination therapy era, the role of CN still deserves attention.