Hofmann Hans-Stefan, Neef Heinz, Krohe Katharina, Andreev Petko, Silber Rolf-Edgar
Department of Cardio-Thoracic Surgery, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Strasse 40, 06097 Halle, Germany.
Eur Urol. 2005 Jul;48(1):77-81; discussion 81-2. doi: 10.1016/j.eururo.2005.03.004. Epub 2005 Mar 20.
Pulmonary metastasectomy as well as immunotherapy have reproducible, albeit limited efficacy in advanced renal cell carcinoma (RCC). We examined whether metastasectomy improved overall survival compared with results of immunotherapy.
Between 1975 and 2003, 64 patients (41 men, 23 women) underwent pulmonary resection of metastatic RCC. Only patients who met the criteria for potentially curative operation, that means, control of primary tumor, ability to resect metastatic disease and no other extrapulmonary metastases, were included.
The overall 5-year survival was 33.4% (median survival: 39.2 months). A significant longer survival was observed using multivariate analysis in patients with complete pulmonary resection (R0), with a 5-year survival of 39.9% and a median survival of 46.6 months in correlation to patients with incomplete resection (5-year survival 0%, median survival 13.3 months). In multivariate analysis patients with synchronous metastases had a significant worse prognosis in correlation to patients with metachronous metastases. The 5-year survival of curative resected patients with metachronous metastases was 43.7% versus 0% for synchronous metastases, respectively. In patients with solitary metastasis and R0 resection, we observed a 5-year survival of 49%, whereas the rate was 23% in patients with more than a single metastasis. When establishing prognostic groups as suggested by the International Registry based on the risk factors disease-free interval, number of metastasis and complete resection the group with the best prognosis showed a 5-year survival of 52% (median survival 75.2 months).
Metastasectomy nowadays is the best treatment option in cases with technical resectable metastases with as much as possible good prognostic factors (metachronous metastases with long DFI, number up to 6 metastases).
肺转移瘤切除术以及免疫疗法在晚期肾细胞癌（RCC）中具有可重复的疗效，尽管疗效有限。我们研究了与免疫疗法相比，转移瘤切除术是否能改善总生存期。
1975年至2003年间，64例患者（41例男性，23例女性）接受了转移性RCC的肺切除术。仅纳入符合潜在治愈性手术标准的患者，即原发肿瘤得到控制、能够切除转移病灶且无其他肺外转移。
总体5年生存率为33.4%（中位生存期：39.2个月）。多因素分析显示，肺完全切除（R0）的患者生存期显著更长，5年生存率为39.9%，中位生存期为46.6个月，而不完全切除的患者5年生存率为0%，中位生存期为13.3个月。多因素分析显示，与异时性转移患者相比，同时性转移患者的预后明显更差。异时性转移的治愈性切除患者5年生存率为43.7%，而同时性转移患者为0%。在孤立转移且R0切除的患者中，我们观察到5年生存率为49%，而转移灶多于一个的患者这一比例为23%。根据国际登记处基于无病生存期、转移灶数量和完全切除等危险因素建议建立预后分组时，预后最佳的组5年生存率为52%（中位生存期75.2个月）。
如今，对于技术上可切除且具有尽可能多良好预后因素（异时性转移且无病生存期长、转移灶数量多达6个）的转移灶，转移瘤切除术是最佳治疗选择。
