Department of Urology, Tokyo Women's Medical University, Tokyo, Japan.
Department of Urology, Tokyo Women's Medical University, Tokyo, Japan.
Urol Oncol. 2020 May;38(5):515-520. doi: 10.1016/j.urolonc.2020.02.003. Epub 2020 Mar 4.
Complete metastasectomy is expected to improve the survival of patients with metastatic renal cell carcinoma (mRCC). However, many patients develop re-recurrence, despite achieving complete remission with surgery. We examined recurrence-free survival (RFS) and analyzed predictive factors for recurrence after complete metastasectomy.
Fifty-one patients with mRCC who underwent complete metastasectomy between 2008 and 2018 were included in this study. Multivariate Cox regression analyses were performed to identify the prognostic factors for RFS.
Of 51 patients, 6 (12%) had multiple metastatic sites and 45 (88%) had solitary metastasis. The pathological subtype was clear cell in 42 (82%), papillary in 8 (17%), and other subtype in 1 (2%) patient. Sarcomatoid features were found in 2 (4%) patients. The Memorial Sloan Kettering Cancer Center risk category was favorable in 43%, intermediate in 53%, and poor in 4% of patients. The median duration from nephrectomy to metastasectomy was 32 months. Of the total cohort, 39 patients (74%) developed recurrence after complete metastasectomy. The median RFS was 22 months, and the 2- and 5-year RFS rates were 45% and 25%, respectively. Multivariate Cox regression revealed that ≥2 metastatic sites (vs. 1 site; HR = 4.52; P = 0.024) and sarcomatoid features (HR = 11.5; P = 0.0171) were independent predictive factors for recurrence. The 2- and 5-year cancer-specific survival rates were 98% and 82%, respectively.
The number of metastatic sites and sarcomatoid features were associated with recurrence after complete metastasectomy, which suggests that careful observation is required for such patients, even after achieving complete remission with metastasectomy.
完全转移切除术有望提高转移性肾细胞癌（mRCC）患者的生存率。然而，许多患者尽管通过手术实现了完全缓解，但仍会复发。我们检查了无复发生存期（RFS），并分析了完全转移切除术后复发的预测因素。
本研究纳入了 2008 年至 2018 年间接受完全转移切除术的 51 例 mRCC 患者。采用多变量 Cox 回归分析确定 RFS 的预后因素。
51 例患者中，6 例（12%）有多个转移部位，45 例（88%）有单发转移。病理亚型为透明细胞 42 例（82%）、乳头状 8 例（17%）和其他类型 1 例（2%）。2 例（4%）患者有肉瘤样特征。纪念斯隆凯特琳癌症中心风险类别为 4%的患者预后差，53%的患者为中间风险，43%的患者为预后良好。从肾切除术到转移切除术的中位时间为 32 个月。在总队列中，39 例（74%）患者在完全转移切除术后复发。中位 RFS 为 22 个月，2 年和 5 年 RFS 率分别为 45%和 25%。多变量 Cox 回归显示，≥2 个转移部位（vs. 1 个部位；HR=4.52；P=0.024）和肉瘤样特征（HR=11.5；P=0.0171）是复发的独立预测因素。2 年和 5 年癌症特异性生存率分别为 98%和 82%。
转移部位的数量和肉瘤样特征与完全转移切除术后的复发有关，这表明即使在转移切除术后完全缓解，也需要对这些患者进行密切观察。
