van der Poel H G, Roukema J A, Horenblas S, van Geel A N, Debruyne F M
Department of Urology, University Hospital Nijmegen, Rotterdam, The
Eur Urol. 1999;35(3):197-203. doi: 10.1159/000019849.
In 60-70% of patients with renal cell carcinoma (RCC), metastases develop in the course of the disease. In the present analysis, the surgical management of metastases is described, and survival data are presented. This retrospective analysis may help in the management of future cases. Due to the retrospective nature of the data, no comparison between surgical and nonsurgical management is possible.
Between 1985 and 1995, 152 resections of RCC metastases were performed in 101 patients at four Dutch Hospitals. Thirty-five and 6 patients had metastases resected 2 and 3 times, respectively. In most patients, the primary tumor was resected (n = 95). Resections were performed for metastases at different locations: lung n = 54, bone n = 42, lymph nodes n = 18, cerebrum n = 12 and locations in the spinal canal, thyroid, bowel, and testis. Skin excisions were excluded from the analysis. Solitary metastases were resected in 40 patients.
Median survival after the initial metastasectomy was 28 months. Initial tumor stage, grade, or size were not related to metastasis location or survival. The number of initially resected pulmonary metastases was of no influence on survival, however, multiple consecutive resections were related with longer survival. Patients with solitary metastases (n = 40) did not show longer survival after the first metastasectomy compared to no solitary lesions. Better survival was found for lung metastases compared to other tumor locations (p = 0.0006, log rank test) and for patients that were clinically tumor free after metastasectomy (p = 0.0230, log rank test). Additional immuno- or radiotherapy did not independently influence survival. Time interval between primary tumor resection and metastasectomy correlated positively with survival: a tumor-free interval of more than 2 years between primary tumor and metastasis was accompanied by a longer disease-specific survival after metastasectomy. Eleven patients were free of disease after metastasectomy with a median time of 47 (14-65) months. The median time of hospital admittance for metastasectomy was 9 days (4-64). Lethal complications were found in 2 patients. Long-term (>5 years) disease-free survival was achieved in 7% of patients whereas 14% of patients were free of disease with a minimal follow-up of 45 months.
(1) Surgical management of metastases could be performed with short hospital stay, and low complication rates were found. (2) Disease-free survival was found in 14 and 7%, with follow-ups of at least 45 and 60 months, respectively. (3) The longest survival was found after surgery for pulmonary lesions. (4) Resection of solitary metastases did not result in longer survival compared to resection of nonsolitary lesions. (5) An interval shorter than 2 years between primary tumor and metastases was correlated with a shorter disease-specific survival.
在60%-70%的肾细胞癌（RCC）患者中，疾病进程中会发生转移。在本分析中，描述了转移灶的外科治疗方法，并给出了生存数据。这项回顾性分析可能有助于未来病例的管理。由于数据的回顾性，无法对手术治疗和非手术治疗进行比较。
1985年至1995年期间，荷兰四家医院的101例患者进行了152次RCC转移灶切除术。35例和6例患者分别接受了2次和3次转移灶切除术。大多数患者的原发肿瘤被切除（n = 95）。对不同部位的转移灶进行了切除：肺转移灶n = 54，骨转移灶n = 42，淋巴结转移灶n = 18，脑转移灶n = 12，以及椎管、甲状腺、肠道和睾丸部位的转移灶。皮肤切除术被排除在分析之外。40例患者切除了孤立性转移灶。
初次转移灶切除术后的中位生存期为28个月。初始肿瘤分期、分级或大小与转移部位或生存期无关。初次切除的肺转移灶数量对生存期无影响，然而，多次连续切除与更长的生存期相关。与非孤立性转移灶患者相比，孤立性转移灶患者（n = 40）在首次转移灶切除术后并未显示出更长的生存期。与其他肿瘤部位相比，肺转移灶患者的生存期更好（p = 0.0006，对数秩检验），转移灶切除术后临床无肿瘤的患者生存期更好（p = 0.0230，对数秩检验）。额外的免疫治疗或放疗并未独立影响生存期。原发肿瘤切除与转移灶切除之间的时间间隔与生存期呈正相关：原发肿瘤与转移灶之间无瘤间隔超过2年，转移灶切除术后疾病特异性生存期更长。11例患者转移灶切除术后无疾病，中位时间为47（14 - 65）个月。转移灶切除的中位住院时间为9天（4 - 64天）。2例患者出现致命并发症。7%的患者实现了长期（>5年）无病生存，而14%的患者在至少随访45个月时无疾病。
（1）转移灶的外科治疗住院时间短，并发症发生率低。（2）分别在至少45个月和60个月的随访中，无病生存率为14%和7%。（3）肺转移灶手术后生存期最长。（4）与非孤立性转移灶切除相比，孤立性转移灶切除并未导致更长的生存期。（5）原发肿瘤与转移灶之间的间隔短于2年与疾病特异性生存期缩短相关。
