Kim Sung Han, Kim Jung Kwon, Park Boram, Joo Jungnam, Joung Jae Young, Seo Ho Kyung, Lee Kang Hyun, Chung Jinsoo
Department of Urology, Center for Prostate Cancer, Research Institute and Hospital of National Cancer Center, Goyang, Korea.
Biometrics Research Branch, Division of Cancer Epidemiology and Prevention, Research Institute and Hospital of National Cancer Center, Goyang, Korea.
Oncotarget. 2017 Jul 25;8(30):49615-49624. doi: 10.18632/oncotarget.17865.
To compare survival outcomes for renal embolization (RE) to cytoreductive nephrectomy (CN) and no primary renal treatment (NT) among patients with synchronous metastatic renal cell carcinoma (mRCC) treated using either targeted therapy (TT) or immunotherapy (IT).
The median follow-up duration was 81.3 months, with a duration of first-line treatment of 3.5 months. Among the 211 patients, the median PFS and OS were 4.4 and 10.6 months. Specifically for patients receiving TT (124 patients), the PFS and OS were 5.5 and 12.0 months. An intervention effect was identified only for OS, with a median OS of 20.1, 8.8 and 9.3 months for CN, RE and NT, respectively. After stratification by risk classification, CN provided a significant benefit on OS, compared to RE and NT, for patients with an intermediate risk (MSKCC). For those with a poor risk (Heng criteria), NT provided better survival than PFS (p=0.003), and a comparable survival to RE (p > 0.05).
Retrospective analysis of 211 patients, 87 treated with IT and 124 with TT, retrieved from our RCC database. Patients' risk factors for survival was evaluated using the Heng and MSKCC criteria, with only patients with an intermediate or poor survival risk included in the analysis. Between-group comparisons were evaluated with respect to progression-free survival (PFS) and overall survival (OS).
The differential effect of CN and RE on OS appears to be modulated by risk classification. In patients with a poor risk, RE should be implemented after careful consideration of comorbidities and life expectancy.
比较在接受靶向治疗（TT）或免疫治疗（IT）的同步转移性肾细胞癌（mRCC）患者中，肾栓塞术（RE）与减瘤性肾切除术（CN）以及不进行原发性肾脏治疗（NT）的生存结果。
中位随访时间为81.3个月，一线治疗时间为3.5个月。在211例患者中，中位无进展生存期（PFS）和总生存期（OS）分别为4.4个月和10.6个月。具体而言，接受TT治疗的患者（124例），PFS和OS分别为5.5个月和12.0个月。仅在OS方面发现了干预效果，CN、RE和NT的中位OS分别为20.1个月、8.8个月和9.3个月。按风险分类分层后，对于中危（MSKCC）患者，与RE和NT相比，CN在OS方面具有显著益处。对于低危（Heng标准）患者，NT在生存方面优于PFS（p = 0.003），且与RE的生存率相当（p>0.05）。
对从我们的肾细胞癌数据库中检索出的211例患者进行回顾性分析，其中87例接受IT治疗，124例接受TT治疗。使用Heng和MSKCC标准评估患者的生存风险因素，分析仅纳入生存风险为中危或低危的患者。对无进展生存期（PFS）和总生存期（OS）进行组间比较。
CN和RE对OS的不同影响似乎受风险分类调节。对于低危患者，在仔细考虑合并症和预期寿命后应实施RE。
