Terakawa Tomoaki, Hussein Ahmed A, Bando Yukari, Guru Khurshid A, Furukawa Junya, Shigemura Katsumi, Harada Kenichi, Hinata Nobuyuki, Nakano Yuzou, Fujisawa Masato
Department of Urology, Kobe University Graduate School of Medicine, Kobe, Hyogo Prefecture, Japan.
Department of Urology, Roswell Park Cancer Institute, Buffalo, New York, USA.
Anticancer Drugs. 2018 Jul;29(6):565-571. doi: 10.1097/CAD.0000000000000627.
The aim of this study was to investigate the clinical benefit of presurgical therapy with pazopanib in renal cell carcinoma (RCC) patients with a tumor thrombus extending to a high level in the vena cava. A retrospective review was performed for seven consecutive patients with RCC and tumor thrombus involving the vena cava above the hepatic vein (level 3-4, Mayo Clinic classification) treated with pazopanib without initial cytoreductive nephrectomy at our institution. The effect of pazopanib was assessed in terms of the primary site response, thrombus diameter, and height (before and after treatment) on computed tomography or MRI. The tumor thrombus level before the induction of pazopanib was 3 in one patient and 4 in the remaining six patients. After pazopanib, shrinkage of the primary site and thrombus diameter and length were observed in all patients except one (with a rhabdoid tumor). The mean decreases of primary tumor diameter, tumor thrombus diameter, and length were 14, 9, and 31 mm, respectively. The tumor thrombus level decreased in three (43%) patients and remained stable in the remaining patient. Our findings suggest that presurgical treatment with pazopanib may shrink the tumor thrombus and decrease the surgical invasiveness in RCC patients with a high-level tumor thrombus.
本研究的目的是调查帕唑帕尼术前治疗对肿瘤血栓延伸至腔静脉高位的肾细胞癌（RCC）患者的临床益处。对在我院接受帕唑帕尼治疗且未进行初始减瘤性肾切除术的7例连续的RCC患者及累及肝静脉以上腔静脉（梅奥诊所分类3 - 4级）的肿瘤血栓患者进行了回顾性分析。根据计算机断层扫描或磁共振成像上的原发部位反应、血栓直径和高度（治疗前后）评估帕唑帕尼的疗效。帕唑帕尼诱导治疗前，1例患者的肿瘤血栓水平为3级，其余6例为4级。除1例（横纹肌样瘤）外，所有患者在使用帕唑帕尼后均观察到原发部位缩小以及血栓直径和长度减小。原发肿瘤直径、肿瘤血栓直径和长度的平均减小分别为14、9和31毫米。3例（43%）患者的肿瘤血栓水平下降，其余患者保持稳定。我们的研究结果表明，帕唑帕尼术前治疗可能会缩小肿瘤血栓并降低肿瘤血栓高位的RCC患者的手术侵袭性。
