Grüllich Carsten, Vallet Sonia, Hecht Christopher, Duensing Stephan, Hadaschik Boris, Jäger Dirk, Hohenfellner Markus, Pahernik Sascha
Department of Medical Oncology, National Center for Tumor Diseases Heidelberg, Heidelberg University Hospital, Heidelberg, Germany.
Department of Medical Oncology, National Center for Tumor Diseases Heidelberg, Heidelberg University Hospital, Heidelberg, Germany.
Urol Oncol. 2016 May;34(5):238.e9-17. doi: 10.1016/j.urolonc.2015.11.022. Epub 2015 Dec 28.
The primary treatment approach to locoregional renal cell carcinoma (RCC) is surgical resection. Most relapses occur within the first 2 years but some patients experience late recurrences. Surgical resection of oligometastatic disease may be considered a curative option for relapsed RCC. However, limited data are available of long-term follow-up of late relapse regarding treatment choice.
We identified 104 patients with RCC from our database, who relapsed after≥2 years from resection of their primary tumor. Median age at primary diagnosis was 61 years and sex distribution was F:M = 40:64. Histology was clear cell, n = 103 and papillary, n = 1. Sites of relapse were local, n = 14 (13.4%); lung only, n = 25 (24.0%); or extrapulmonary, n = 65 (62.5%). Treatment at first relapse was local therapy (LT) in n = 60 (57.7%) patients, of these, n = 55 patients had surgery done and n = 5 patients had underwent radiotherapy. Systemic therapy was used in n = 9 (8.7%) patients. Overall, 35 patients received best supportive care (33.7%).
We found a median overall survival (OS) of 49.8 months (95% CI: 29.3-70.2) and a progression-free survival (PFS) of 21.6 months (95% CI: 12.6-30.5) for all patients. Patients receiving LT had a median OS of 99.9 months (95% CI: 77.2-122.6) and a PFS of 31.1 months (95% CI: 21.5-40.7). Patients treated with systemic therapy, in turn, had an OS of 21.1 months (95% CI: 8.4-33.8) and a PFS of 4 months (95% CI: 1.0-6.2). Patients who received best supportive care had an OS of 10 months (95% CI: 1.3-18.7). This difference was highly significant (log rank for PFS: P<0.001; log rank for OS: P<0.003). Subgroup analysis of the LT group showed a superior outcome for local relapses (OS: not reached, PFS: 61.4mo [95% CI: 28.5-9.2]) compared to visceral relapses (OS: 35.5mo [95% CI: 17.9-53.1], PFS: 21.1mo [95% CI: 19.2-22.9]).
Local salvage therapy should be considered the first therapeutic option in late relapse of RCC irrespective of the site of relapse.
局部区域性肾细胞癌（RCC）的主要治疗方法是手术切除。大多数复发发生在头2年内，但有些患者会出现晚期复发。寡转移疾病的手术切除可能被视为复发RCC的一种治愈性选择。然而，关于治疗选择的晚期复发的长期随访数据有限。
我们从数据库中识别出104例RCC患者，他们在原发性肿瘤切除后≥2年复发。初次诊断时的中位年龄为61岁，性别分布为女性：男性 = 40:64。组织学类型为透明细胞，n = 103例，乳头状，n = 1例。复发部位为局部，n = 14例（13.4%）；仅肺部，n = 25例（24.0%）；或肺外，n = 65例（62.5%）。首次复发时的治疗方法为局部治疗（LT）的有n = 60例（57.7%）患者，其中，n = 55例患者接受了手术，n = 5例患者接受了放疗。9例（8.7%）患者采用了全身治疗。总体而言，35例患者接受了最佳支持治疗（33.7%）。
我们发现所有患者的中位总生存期（OS）为49.8个月（95%置信区间：29.3 - 70.2），无进展生存期（PFS）为21.6个月（95%置信区间：12.6 - 30.5）。接受LT的患者中位OS为99.9个月（95%置信区间：77.2 - 122.6），PFS为31.1个月（95%置信区间：21.5 - 40.7）。反过来，接受全身治疗的患者OS为21.1个月（95%置信区间：8.4 - 33.8），PFS为4个月（95%置信区间：1.0 - 6.2）。接受最佳支持治疗的患者OS为10个月（95%置信区间：1.3 - 18.7）。这种差异非常显著（PFS的对数秩检验：P<0.001；OS的对数秩检验：P<0.003）。LT组的亚组分析显示，与内脏复发相比，局部复发的预后更好（OS：未达到，PFS：61.4个月[95%置信区间：28.5 - 9.2]）（OS：35.5个月[95%置信区间：17.9 - 53.1]，PFS：21.1个月[95%置信区间：19.2 - 22.9]）。
无论复发部位如何，局部挽救性治疗都应被视为RCC晚期复发的首选治疗方案。
