Department of Urology, University Hospital Jena, Lessingstr 1, 07743 Jena, Germany.
J Cancer Res Clin Oncol. 2010 Jun;136(6):905-10. doi: 10.1007/s00432-009-0732-z. Epub 2009 Dec 12.
Patients with metastatic papillary renal cell carcinoma (RCC) show special clinical behavior compared to patients with other histologic subtypes of RCC. This study aimed to assess the relevance of surgical and systemic options used in treatment of these patients prior to the recent era of targeted therapies.
Retrospectively, we assessed clinical data of 61 patients with metastatic papillary RCC who were treated at eight centers in Germany.
Median follow-up was 20 (range 1-114) months and median age at time of diagnosis was 62 (range 24-85) years. Men were affected predominantly (50/61; 82%). Twenty-one patients (34%) showed metastases at time of diagnosis. In the remaining 40 patients, median time to development of metastases was 30.4 (range 3-143; mean 16.5) months. Sites of metastases were lung (37; 61%), bone (24; 38%), liver (20; 33%), lymph nodes (24; 38%), and local recurrence (17; 28%). Others sites of disease were brain metastases (6 patients/10%), peritoneal carcinosis (5 patients/8%), and others. A surgical approach with potentially curative intention was performed primarily in 11 patients (18%). 31 patients received an immuno- (interferon-alpha +/- interleukin-2) or immunochemotherapy as first line treatment for metastatic disease. Overall, 42/61 patients (69%) received systemic therapy. Supportive care only was performed in 12 patients (20%) because of poor performance status. Median overall survival after diagnosis of metastatic disease was longer than 48 months in patients with tumor resection (n = 11) compared to 13.0 +/- 4.3 months 95% CI 4.5-21.5 (n = 42) months in patients without surgical approach.
Complete resection of metastases represents a valid option in management of patients with relapsing or metastatic papillary RCC.
与其他组织学类型的肾细胞癌（RCC）相比，转移性乳头状 RCC 患者表现出特殊的临床行为。本研究旨在评估在最近靶向治疗时代之前，这些患者在治疗中使用的手术和系统治疗选择的相关性。
回顾性评估了在德国 8 个中心接受治疗的 61 例转移性乳头状 RCC 患者的临床数据。
中位随访时间为 20 个月（范围 1-114 个月），诊断时的中位年龄为 62 岁（范围 24-85 岁）。男性受影响居多（50/61；82%）。21 例（34%）患者在诊断时即出现转移。在其余 40 例患者中，中位转移发生时间为 30.4 个月（范围 3-143 个月；平均 16.5 个月）。转移部位为肺（37 例；61%）、骨（24 例；38%）、肝（20 例；33%）、淋巴结（24 例；38%）和局部复发（17 例；28%）。其他疾病部位包括脑转移（6 例/10%）、腹膜癌（5 例/8%）和其他部位。11 例患者（18%）进行了有潜在治愈意图的手术治疗。31 例患者接受了免疫（干扰素-α +/- 白细胞介素-2）或免疫化疗作为转移性疾病的一线治疗。总的来说，61 例患者中有 42 例（69%）接受了系统治疗。由于一般状况较差，12 例患者（20%）仅接受支持性治疗。与未行手术治疗的患者（n=42）相比，肿瘤切除患者（n=11）的转移性疾病诊断后中位总生存期超过 48 个月（95%CI 4.5-21.5）。
转移性乳头状 RCC 患者复发或转移时，完全切除转移灶是一种有效的治疗选择。
