Cangiano T, Liao J, Naitoh J, Dorey F, Figlin R, Belldegrun A
Department of Urology, University of California Los Angeles School of Medicine, 90095, USA.
J Clin Oncol. 1999 Feb;17(2):523-8. doi: 10.1200/JCO.1999.17.2.523.
Sarcomatoid variants of renal cell carcinoma (RCC) are aggressive tumors that respond poorly to immunotherapy. We report the outcomes of 31 patients with sarcomatoid RCC treated with a combination of surgical resection and immunotherapy.
Patients were identified from the database of the University of California Los Angeles Kidney Cancer Program. We retrospectively reviewed the cases of 31 consecutive patients in whom sarcomatoid RCC was diagnosed between 1990 and 1997. Clinical stage, sites of metastasis, pathologic stage, and type of immunotherapy were abstracted from the medical records. The primary end point analyzed was overall survival, and a multivariate analysis was performed to distinguish any factors conferring an improved survivorship.
Twenty-six percent of patients were male and 74% were female, and the median age was 59 years (range, 34 to 73 years). Length of follow-up ranged from 2 to 77 months (mean, 21.4 months). Twenty-eight patients (84%) had known metastases at the time of radical nephrectomy (67% had lung metastases and 40% had bone, 21% had liver, 33% had lymphatic, and 15% had brain metastases). Twenty-five patients (81%) received immunotherapy, including low-dose interleukin (IL)-2-based therapy (five patients), tumor-infiltrating lymphocyte-based therapy plus IL-2 (nine patients), high-dose IL-2-based therapy (nine patients), dendritic cell vaccine-based therapy (one patient), and interferon alpha-based therapy alone (one patient). Two patients (6%) achieved complete responses (median duration, 46+ months) and five patients (15%) achieved partial responses (median duration, 36 months). One- and 2-year overall survival rates were 48% and 37%, respectively. Using a multivariate analysis, age, sex, and percentage of sarcomatoid tumor (< or >50%) did not significantly correlate with survival. Improved survival was found in patients receiving high-dose IL-2 therapy compared with patients treated with surgery alone or any other form of immunotherapy (P = .025). Adjusting for age, sex, and percentage of sarcomatoid tumor, the relative risk of death was 10.4 times higher in patients not receiving high-dose IL-2 therapy. Final pathologic T stage did not correlate significantly with outcome, but node-positive patients had a higher death rate per year of follow-up than did the rest of the population (1.26 v 0.76, Cox regression analysis).
Surgical resection and high-dose IL-2-based immunotherapy may play a role in the treatment of sarcomatoid RCCs in select patients.
肾细胞癌（RCC）的肉瘤样变体是侵袭性肿瘤，对免疫疗法反应不佳。我们报告了31例接受手术切除和免疫疗法联合治疗的肉瘤样RCC患者的治疗结果。
从加利福尼亚大学洛杉矶分校肾癌项目数据库中识别患者。我们回顾性分析了1990年至1997年间连续诊断为肉瘤样RCC的31例患者的病例。从病历中提取临床分期、转移部位、病理分期和免疫疗法类型。分析的主要终点是总生存期，并进行多变量分析以区分任何有助于提高生存率的因素。
26%的患者为男性，74%为女性，中位年龄为59岁（范围34至73岁）。随访时间为2至77个月（平均21.4个月）。28例患者（84%）在根治性肾切除时已有已知转移（67%有肺转移，40%有骨转移，21%有肝转移，33%有淋巴转移，15%有脑转移）。25例患者（81%）接受了免疫疗法，包括基于低剂量白细胞介素（IL）-2的疗法（5例）、基于肿瘤浸润淋巴细胞的疗法加IL-2（9例）、基于高剂量IL-2的疗法（9例）、基于树突状细胞疫苗的疗法（1例）和单独基于干扰素α的疗法（1例）。2例患者（6%）获得完全缓解（中位持续时间46 +个月），5例患者（15%）获得部分缓解（中位持续时间36个月）。1年和2年总生存率分别为48%和37%。通过多变量分析，年龄、性别和肉瘤样肿瘤百分比（<或>50%）与生存率无显著相关性。与单独接受手术或任何其他形式免疫疗法的患者相比，接受高剂量IL-2疗法的患者生存率提高（P = 0.025）。调整年龄、性别和肉瘤样肿瘤百分比后，未接受高剂量IL-2疗法的患者死亡相对风险高10.4倍。最终病理T分期与预后无显著相关性，但淋巴结阳性患者每年的死亡率高于其他人群（1.26对0.76，Cox回归分析）。
手术切除和基于高剂量IL-2的免疫疗法可能在部分肉瘤样RCC患者的治疗中发挥作用。
