Pantuck Allan J, Zisman Amnon, Dorey Frederich, Chao Debby H, Han Ken-Ryu, Said Jonathan, Gitlitz Barbara, Belldegrun Arie S, Figlin Robert A
Department of Urology, University of California School of Medicine, Los Angeles, California 90095-1738, USA.
Cancer. 2003 Jun 15;97(12):2995-3002. doi: 10.1002/cncr.11422.
The current study was performed to determine the impact of the presence of retroperitoneal lymphadenopathy on the survival and response to immunotherapy of patients with metastatic renal cell carcinoma (RCC).
A retrospective cohort study was performed with outcome assessment based on the chart review of demographic, clinical, and pathologic data from 1087 patients. Patients with RCC who did not present with metastatic disease, who did not undergo nephrectomy as part of their cancer treatment, and those in whom either the lymph node (N) or metastatic (M) status was unknown, were excluded. A total of 322 M1 patients who met these criteria and who underwent nephrectomy for unilateral RCC formed the principal study population.
Two hundred thirty-six patients presented with N0M1 disease and 86 patients presented with N+M1 disease. In M1 patients, the presence of positive regional lymph nodes was associated with larger sized, higher grade, locally advanced primary tumors that were more commonly associated with sarcomatoid features. N0M1 patients were more likely to achieve an objective response to systemic immunotherapy compared with N+M1 patients (P = 0.01). N+M1 patients overall had worse short-term and long-term survival compared with N0M1 patients, with a median survival of 10.5 months compared with 20.4 months, respectively. The median survival of N0M1 patients was improved to 28 months in those who received adjunctive immunotherapy (P = 0.0008), whereas the median survival of patients with N+M1 disease was the same in those treated with and those treated without adjunctive immunotherapy (P = 0.18).
Even in the modern era of systemic immunotherapy, the presence of regional lymphadenopathy exerts a detrimental effect on the survival of patients with metastatic RCC. Lymph node status is a strong predictor of the failure to achieve either an objective immunotherapy response or an improvement in survival when immunotherapy is given as an adjunctive treatment after cytoreductive nephrectomy. However, in multivariate analysis, including both clinical and pathologic variables, lymph node status was found to have less of an impact on survival than primary tumor stage and grade and patient performance status.
本研究旨在确定腹膜后淋巴结肿大对转移性肾细胞癌（RCC）患者生存率及免疫治疗反应的影响。
进行一项回顾性队列研究，通过查阅1087例患者的人口统计学、临床和病理数据进行结局评估。排除未出现转移性疾病、未将肾切除术作为癌症治疗一部分以及淋巴结（N）或转移（M）状态不明的RCC患者。共有322例符合这些标准且因单侧RCC接受肾切除术的M1患者构成主要研究人群。
236例患者为N0M1疾病，86例患者为N+M1疾病。在M1患者中，阳性区域淋巴结的存在与更大尺寸、更高分级、局部晚期的原发性肿瘤相关，这些肿瘤更常伴有肉瘤样特征。与N+M1患者相比，N0M1患者更有可能对全身免疫治疗产生客观反应（P = 0.01）。与N0M1患者相比，N+M1患者总体短期和长期生存率更差，中位生存期分别为10.5个月和20.4个月。接受辅助免疫治疗的N0M1患者中位生存期提高到28个月（P = 0.0008），而接受和未接受辅助免疫治疗的N+M1疾病患者中位生存期相同（P = 0.18）。
即使在全身免疫治疗的现代时代，区域淋巴结肿大对转移性RCC患者的生存仍有不利影响。淋巴结状态是在减瘤性肾切除术后给予免疫治疗时无法实现客观免疫治疗反应或生存率改善的有力预测指标。然而，在包括临床和病理变量的多变量分析中，发现淋巴结状态对生存的影响小于原发性肿瘤分期、分级和患者体能状态。
