De Gobbi Alberto, Biasoni Davide, Catanzaro Mario, Nicolai Nicola, Piva Luigi, Stagni Silvia, Torelli Tullio, Procopio Giuseppe, Verzoni Elena, Grassi Paolo, Colecchia Maurizio, Paolini Biagio, Spreafico Carlo, Marchianò Alfonso, Salvioni Roberto
1 Department of Urology, Fondazione IRCCS Istituto dei Tumori, Milan - Italy.
Current affiliation: Department of Urology, Treviso Hospital, Ulss 2 Marca Trevigiana, Treviso - Italy.
Tumori. 2018 Oct;104(5):388-393. doi: 10.5301/tj.5000596. Epub 2018 May 8.
: Renal cell carcinoma (RCC) is the most common tumor of the kidney. Considering the TNM classification of 2009, locally advanced and metastatic diseases are included in the groups stage III and IV. The surgical treatment of these tumors could be divided into 3 categories: (1) curative (nephrectomy and/or metastasectomy), (2) cytoreductive, and (3) palliative. Targeted agents showed impressive antitumor efficacy and prolongation of progression-free survival. The integration between target therapy and surgery in patients with locally advanced or metastatic RCC has sometimes facilitated surgery. We aimed to evaluate patients' response to tyrosine kinase inhibitor (TKI) therapy and the feasibility of surgery after that and to observe complications related to surgery.
: From February 2007 to September 2014 in the Istituto Tumori of Milan, IRCCS, we selected patients with locally advanced or metastatic diseases, treated with target therapy before surgery (which comprised nephrectomy or partial nephrectomy, cytoreductive surgery, and metastasectomy) and cryoablation.
: We selected 33 patients who underwent surgery after TKI therapy. As for response to TKIs, 20 patients (60%) had stable disease, 9 patients (28%) had a partial response, and 4 patients (12%) had progressive disease. A total of 17 patients (51%) presented complications directly or indirectly related to surgery and most of those were classified as grade II Clavien-Dindo score.
: The association between TKI and surgery seems to have no contraindications. Our dataset provides an example of how surgery after TKI is possible in locally advanced metastatic tumor and does not have an excessive rate of postoperative complications.
肾细胞癌（RCC）是最常见的肾脏肿瘤。根据2009年的TNM分类，局部晚期和转移性疾病归为III期和IV期。这些肿瘤的手术治疗可分为3类：（1）根治性（肾切除术和/或转移灶切除术），（2）减瘤性，（3）姑息性。靶向药物显示出令人印象深刻的抗肿瘤疗效和无进展生存期的延长。局部晚期或转移性RCC患者中靶向治疗与手术的联合有时有助于手术进行。我们旨在评估患者对酪氨酸激酶抑制剂（TKI）治疗的反应以及之后手术的可行性，并观察与手术相关的并发症。
2007年2月至2014年9月，在米兰IRCCS肿瘤研究所，我们选择了局部晚期或转移性疾病患者，这些患者在手术（包括肾切除术或部分肾切除术、减瘤手术和转移灶切除术）和冷冻消融术前接受了靶向治疗。
我们选择了33例在TKI治疗后接受手术的患者。至于对TKI的反应，20例患者（60%）病情稳定，9例患者（28%）部分缓解，4例患者（12%）病情进展。共有17例患者（51%）出现了与手术直接或间接相关的并发症，其中大多数被归类为Clavien-Dindo评分II级。
TKI与手术联合似乎没有禁忌证。我们的数据集提供了一个例子，说明局部晚期转移性肿瘤患者在TKI治疗后进行手术是可行的，且术后并发症发生率并不高。
