Tsuchiya K, Uchida T, Kobayashi M, Maeda H, Konno T, Yamanaka H
Department of Urology, Gunma University School of Medicine, Gunma, Japan.
Urology. 2000 Apr;55(4):495-500. doi: 10.1016/s0090-4295(99)00537-3.
To evaluate the anticancer effects of a lipophilic macromolecular anticancer agent, poly(styrene-co-maleic acid)-conjugated neocarzinostatin (SMANCS), dissolved in a lipid contrast medium (Lipiodol) given via the renal artery to patients with renal cell carcinoma.
Among 467 patients with renal cell carcinoma treated between April 1984 and March 1993, 191 were treated with SMANCS dissolved in a lipid contrast medium (a 3:2 mixture of Lipiodol F and Lipiodol Ultrafluid; Lpd). Selective arterial infusion of SMANCS/Lpd was performed at a dose of 1.0 or 1. 5 mg/mL. The infusion was repeated at intervals of about 2 weeks or longer, but the doses and the total number of infusions varied among patients, according to results of computed tomography analysis.
Statistical analysis was performed for 415 patients who met the criteria of this study. Twenty-six surgical patients with metastases who underwent infusion therapy of SMANCS/Lpd for primary lesions showed 3 and 5-year survival rates of 23.0% and 12.8%, respectively; the rates were 19.3% and 9.7% in 31 patients who did not receive SMANCS infusion therapy. In 125 surgical patients without metastases who underwent SMANCS/Lpd infusion, the 5 and 10-year survival rates were 83.0% and 75.2%, respectively, whereas rates of 84.6% and 78.9% were observed in 199 surgical patients whose median tumor size was significantly smaller, however, than the SMANCS/Lpd infusion group. The maximal tumor diameter at the beginning of treatment was significantly larger (mean diameter 70.8 mm) in the SMANCS/Lpd infusion group than in the noninfusion group (59.1 mm). The survival rate was statistically better for patients with tumors of 100 mm diameter or larger in the SMANCS/Lpd infusion group (P <0.05): 5 and 10-year survival rates were 70.4% and 61.6%, respectively, for the infusion group and 64.6% and 50.9% for the group receiving no drug. In patients with larger tumor (greater than 110 mm), the survival rate at 13 years was 75% in the SMANCS/Lpd infusion group and 0% in the surgery group.
Arterial infusion therapy with SMANCS/Lpd appears to be effective for large renal cell carcinoma without metastases in conjunction with surgery.
评估一种亲脂性大分子抗癌剂，即聚（苯乙烯 - 共 - 马来酸）共轭新制癌菌素（SMANCS），溶解于脂质造影剂（碘油）中经肾动脉给予肾细胞癌患者后的抗癌效果。
在1984年4月至1993年3月间接受治疗的467例肾细胞癌患者中，191例接受了溶解于脂质造影剂（碘油F和超液化碘油的3:2混合物；Lpd）中的SMANCS治疗。以1.0或1.5mg/mL的剂量进行SMANCS/Lpd的选择性动脉灌注。灌注每隔约2周或更长时间重复一次，但剂量和灌注总次数因患者而异，具体取决于计算机断层扫描分析结果。
对符合本研究标准的415例患者进行了统计分析。26例有转移的手术患者因原发性病变接受了SMANCS/Lpd灌注治疗，其3年和5年生存率分别为23.0%和12.8%；31例未接受SMANCS灌注治疗的患者，其3年和5年生存率分别为19.3%和9.7%。125例无转移的手术患者接受了SMANCS/Lpd灌注，其5年和10年生存率分别为83.0%和75.2%；而199例手术患者的5年和10年生存率分别为84.6%和78.9%，不过这些患者的肿瘤中位大小明显小于SMANCS/Lpd灌注组。SMANCS/Lpd灌注组治疗开始时的最大肿瘤直径明显更大（平均直径70.8mm），而非灌注组为59.1mm。SMANCS/Lpd灌注组中肿瘤直径100mm或更大的患者生存率在统计学上更好（P<0.05）：灌注组的5年和10年生存率分别为70.4%和61.6%，未接受药物治疗组为64.6%和50.9%。对于肿瘤更大（大于110mm）的患者，SMANCS/Lpd灌注组13年生存率为75%，手术组为0%。
SMANCS/Lpd动脉灌注治疗联合手术似乎对无转移的大型肾细胞癌有效。
