Villarreal-Garza Cynthia, Perez-Alvarez Sandra I, Gonzalez-Espinoza Ivan R, Leon-Rodriguez Eucario
Department of Hematology and Oncology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico.
World J Oncol. 2010 Aug;1(4):149-157. doi: 10.4021/wjon232w. Epub 2010 Aug 29.
To report location and management of atypical metastases from renal cell carcinoma (RCC) in the Instituto Nacional de Ciencias Medicas e Investigacion Salvador Zubiran (INCMNSZ) in Mexico City.
Between 1987 to 2009, 545 patients with RCC were retrospectively identified at the INCMNSZ. Patients with unusual metastases confirmed by histopathology were analyzed. Epidemiological, clinical, diagnosis, treatment and outcome data were reviewed.
Sixty patients developed 98 unusual metastases secondary to RCC. The group was comprised of 35 men (58.3%), with a median age of 60 years at diagnosis. Metachronous unusual metastases with primary renal cancer were observed in 37 individuals (61.7%). Median time from primary RCC diagnosis to the first unusual metastasis was 16.5 months. Median survival from diagnosis of the first unusual metastasis to death was 5.0 months (CI 95%: 2.8-7.2 months). Patients with an initial solitary metastatic lesion in an unusual site (28.3%) had a better survival compared to patients who primarily presented with multiple metastases, 17.0 (CI 95%: 6.1-27.9) Vs 3.0 months (CI 95%: 0.9-5.1), p = 0.001. Unusual metastasis resection (21 patients) improved survival, 25.0 (CI 95%: 5.1-44.9) Vs 3.0 months (CI 95%: 0.8-5.2), p < 0.0001. No survival difference was observed between localization of unsual metastases (p = 0.72).
In patients with advanced RCC we suggest an individual diagnostic and surgical approach to achieve complete resection with disease-free margins, even in the presence of unusual metastatic sites, multifocality, or history of metastasectomy. These strategy might provide not only palliation for symptoms, but an opportunity for meaningful disease free and overall survival.
报告墨西哥城萨尔瓦多·苏比拉án国家医学科学与研究机构（INCMNSZ）中肾细胞癌（RCC）非典型转移灶的位置及处理情况。
1987年至2009年间，在INCMNSZ对545例RCC患者进行回顾性研究。对经组织病理学证实有异常转移的患者进行分析。回顾流行病学、临床、诊断、治疗及预后数据。
60例患者出现98处继发于RCC的异常转移灶。该组包括35名男性（58.3%），诊断时中位年龄为60岁。37例患者（61.7%）观察到与原发性肾癌异时性异常转移。从原发性RCC诊断到首次异常转移的中位时间为16.5个月。从首次异常转移诊断到死亡的中位生存期为5.0个月（95%置信区间：2.8 - 7.2个月）。初始在异常部位有孤立转移灶的患者（28.3%）比主要表现为多发转移的患者生存期更长，分别为17.0个月（95%置信区间：6.1 - 27.9）和3.0个月（95%置信区间：0.9 - 5.1），p = 0.001。异常转移灶切除（21例患者）可改善生存期，分别为25.0个月（95%置信区间：5.1 - 44.9）和3.0个月（95%置信区间：0.8 - 5.2），p < 0.0001。异常转移灶的位置之间未观察到生存期差异（p = 0.72）。
对于晚期RCC患者，我们建议采用个体化的诊断和手术方法，以实现切缘无瘤的完整切除，即使存在异常转移部位、多灶性或既往有转移灶切除术史。这些策略不仅可能缓解症状，还可能提供实现无病生存期和总生存期有意义延长的机会。
