Sakai Iori, Miyake Hideaki, Hinata Nobuyuki, Fujisawa Masato
Division of Urology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
Int J Clin Oncol. 2014 Aug;19(4):674-8. doi: 10.1007/s10147-013-0612-z. Epub 2013 Aug 30.
We aimed to review our clinical experience of cytoreductive nephrectomy for patients with metastatic renal cell carcinoma (mRCC) and to identify factors associated with postoperative prognosis in these patients.
This study included a total of 164 Japanese patients with mRCC who underwent cytoreductive nephrectomy and subsequently received immunotherapy and/or molecular-targeted therapy between 2000 and 2010.
Baseline characteristics of the 164 patients were as follows: median age was 66 years; metastatic sites included the lung in 133 (81.1 %), bone in 44 (26.8 %), and other in 37 (22.6 %); and 34 (20.7 %), 106 (64.7 %), and 24 (14.6 %) patients were classified into favorable, intermediate-risk, and poor-risk groups, respectively, according to the Memorial Sloan-Kettering Cancer Center (MSKCC) risk model. As postoperative systemic therapy, 80 patients (48.8 %) were treated with immunotherapy alone; the remaining 84 (51.2 %) received molecular-targeted agents irrespective of previous treatment with immunotherapy. Median overall survival of these 164 patients was 25.8 months. Univariate analysis identified the MSKCC risk classification, preoperative C-reactive protein (CRP) level, metastatic site, nodal involvement, presence of sarcomatoid features, histological subtype, and introduction of molecular-targeted agents as significant predictors of overall survival, among which only the preoperative CRP level and introduction of molecular-targeted agents appeared to be independently associated with overall survival.
Treatment with molecular-targeted agents following cytoreductive nephrectomy may contribute to improve the survival of patients with mRCC compared with immunotherapy alone, and it may be important to employ an aggressive systemic treatment for patients with an increased preoperative value of CRP.
我们旨在回顾转移性肾细胞癌（mRCC）患者减瘤性肾切除术的临床经验，并确定这些患者术后预后的相关因素。
本研究共纳入164例日本mRCC患者，这些患者在2000年至2010年间接受了减瘤性肾切除术，随后接受了免疫治疗和/或分子靶向治疗。
164例患者的基线特征如下：中位年龄为66岁；转移部位包括肺部133例（81.1%）、骨骼44例（26.8%）、其他部位37例（22.6%）；根据纪念斯隆凯特琳癌症中心（MSKCC）风险模型，分别有34例（20.7%）、106例（64.7%）和24例（14.6%）患者被分为低危、中危和高危组。作为术后全身治疗，80例患者（48.8%）仅接受免疫治疗；其余84例（51.2%）接受分子靶向药物治疗，无论之前是否接受过免疫治疗。这164例患者的中位总生存期为25.8个月。单因素分析确定MSKCC风险分类、术前C反应蛋白（CRP）水平、转移部位、淋巴结受累情况、肉瘤样特征的存在、组织学亚型以及分子靶向药物的应用是总生存期的重要预测因素，其中只有术前CRP水平和分子靶向药物的应用似乎与总生存期独立相关。
与单纯免疫治疗相比，减瘤性肾切除术后使用分子靶向药物治疗可能有助于提高mRCC患者的生存率，对于术前CRP值升高的患者采用积极的全身治疗可能很重要。
