Hau Hans Michael, Thalmann Florian, Lübbert Christoph, Morgul Mehmet Haluk, Schmelzle Moritz, Atanasov Georgi, Benzing Christian, Lange Undine, Ascherl Rudolf, Ganzer Roman, Uhlmann Dirk, Tautenhahn Hans-Michael, Wiltberger Georg, Bartels Michael
Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany.
Division of Infectious Diseases and Tropical Medicine, Department of Gastroenterology and Rheumatology, Leipzig University Hospital, Leipzig, Germany.
BMC Surg. 2016 Jul 22;16(1):49. doi: 10.1186/s12893-016-0163-0.
The value of liver-directed therapy (LDT) in patients with metastasic renal cell carcinoma (MRCC) is still an active field of research, particularly in the era of tyrosinkinase inhibitor (TKI) therapy.
The records of 35 patients with MRCC undergoing LDT of metastasic liver lesions between 1992 and 2015 were retrospectively analyzed. Immediate postoperative TKI was given in a subgroup of patients after LDT for metastasic lesions. Uni- and multivariate models were applied to assess overall survival (OS), progression-free survival (PFS) and disease-free survival (DFS).
Following primary tumor (renal cell cancer) resection and LDT, respectively, median OS was better for a total of 16 patients (41 %) receiving immediate postoperative TKI with 151 and 98 months, when compared to patients without TKI therapy with 61 (p = 0.003) and 40 months (p = 0.032). Immediate postoperative TKI was associated with better median PFS (47 months versus 19 months; p = 0.023), whereas in DFS only a trend was observed (51 months versus 19 months; p = 0.110).
LDT should be considered as a suitable additive tool in the era of TKI therapy of MRCC to the liver. In this context, postoperative TKI therapy seems to be associated with better OS and PFS, but not DFS.
肝靶向治疗（LDT）在转移性肾细胞癌（MRCC）患者中的价值仍是一个活跃的研究领域，尤其是在酪氨酸激酶抑制剂（TKI）治疗时代。
回顾性分析了1992年至2015年间35例接受肝转移灶LDT的MRCC患者的记录。部分患者在LDT治疗转移性病灶后立即给予术后TKI。应用单因素和多因素模型评估总生存期（OS）、无进展生存期（PFS）和无病生存期（DFS）。
分别在原发性肿瘤（肾细胞癌）切除和LDT后，共有16例（41%）接受术后立即TKI治疗的患者中位OS较好，分别为151个月和98个月，相比未接受TKI治疗的患者，其OS分别为61个月（p = 0.003）和40个月（p = 0.032）。术后立即给予TKI与更好的中位PFS相关（47个月对19个月；p = 0.023），而在DFS方面仅观察到一种趋势（51个月对19个月；p = 0.110）。
在MRCC肝转移的TKI治疗时代，LDT应被视为一种合适的辅助治疗手段。在此背景下，术后TKI治疗似乎与更好的OS和PFS相关，但与DFS无关。
