Qi Nienie, Wu Pengjie, Chen Jinchao, Li Teng, Ning Xianghui, Wang Jin, Gong Kan
Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, Beijing, China.
Department of Urology, Beijing Hospital, Beijing, China.
World J Surg Oncol. 2017 Jan 5;15(1):4. doi: 10.1186/s12957-016-1066-3.
The aim of the study is to evaluate the role of cytoreductive nephrectomy (CN) with thrombectomy before targeted molecular therapy (TMT) on survival in metastatic renal cell carcinoma (mRCC) with venous tumor thrombus.
We performed a retrospective analysis of 47 patients treated in our center from April 2008 to October 2014. In the study, 20 patients underwent CN with thrombectomy followed by targeted therapy (group 1); 15 patients received targeted therapy alone (group 2); and 12 patients underwent CN with thrombectomy alone (group 3). The overall survival (OS) and cancer-specific survival (CSS) were calculated according to the Kaplan-Meier survival curve method, and prognostic variables were assessed by Cox regression analyses.
The median follow-up times of group 1, group 2, and group 3 were 24.5, 12, and 6.5 months, respectively. During follow-up, in both group 1 and group 3, 12 patients died. In group 2, 14 patients died. The median OS of group 1, group 2, and group 3 was 22, 12, and 6 months, respectively (P < 0.001). Compared with surgery alone and targeted therapy alone, patients with cytoreductive surgery before targeted therapy had statistically better survival benefits (P < 0.001, P = 0.009, respectively). On univariate analysis, the number of metastatic sites (P = 0.004) was a statistically significant prognostic factor influencing OS.
Our single-center experience showed that CN with thrombectomy before targeted therapy improved the survival of patients with mRCC with venous tumor thrombus. The number of metastatic sites was an independent prognostic factor influencing OS.
本研究旨在评估在靶向分子治疗（TMT）前进行减瘤性肾切除术（CN）联合血栓切除术对伴有静脉瘤栓的转移性肾细胞癌（mRCC）患者生存的作用。
我们对2008年4月至2014年10月在本中心接受治疗的47例患者进行了回顾性分析。在该研究中，20例患者接受了CN联合血栓切除术，随后进行靶向治疗（第1组）；15例患者仅接受靶向治疗（第2组）；12例患者仅接受CN联合血栓切除术（第3组）。根据Kaplan-Meier生存曲线法计算总生存期（OS）和癌症特异性生存期（CSS），并通过Cox回归分析评估预后变量。
第1组、第2组和第3组的中位随访时间分别为24.5个月、12个月和6.5个月。随访期间，第1组和第3组均有12例患者死亡。第2组有14例患者死亡。第1组、第2组和第3组的中位OS分别为22个月、12个月和6个月（P＜0.001）。与单纯手术和单纯靶向治疗相比，靶向治疗前接受减瘤手术的患者在生存获益方面具有统计学意义（分别为P＜0.001，P = 0.009）。单因素分析显示，转移部位数量（P = 0.004）是影响OS的具有统计学意义的预后因素。
我们的单中心经验表明，靶向治疗前进行CN联合血栓切除术可提高伴有静脉瘤栓的mRCC患者的生存率。转移部位数量是影响OS的独立预后因素。
