Brozzetti Stefania, Bini Simone, De Lio Nelide, Lombardo Carlo, Boggi Ugo
Surgical Department "Pietro Valdoni", Policlinico Umberto I, University of Rome "La Sapienza", Viale del Policlinico 155, 00161, Rome, Italy.
Division of General and Transplantation Surgery, University of Pisa, Pisa, Italy.
BMC Surg. 2020 May 13;20(1):101. doi: 10.1186/s12893-020-00757-0.
Treatment of pancreatic metastases (PM) from renal cell carcinoma (RCC) is still an issue between surgeons and oncologists, in the era of target-therapy.
Data from 26 patients undergoing resection of PM and extra-PM from RCC, with R0 intention were retrospectively analysed. No one received adjuvant chemotherapy. Patients were divided into two groups; Group A comprehends 14 patients who developed synchronous (5) or methacronous (9) extra-PM. Group B comprehends 12 patients that developed PM only.
No intraoperative mortality was recorded. Complications occurred in 14 patients (53.8%), all but 2 (7.26%) were graded I and II according to Clavien-Dindo classification. Recurrences occurred in 8 patients (30.8%), of whom, 5 (62.5%) were submitted for further resections in other sites. Three-, five- and ten-year observed overall survival were respectively 88,5% [95%CI: 0,56 - 1,33], 76,9% [95%CI: 0,47 - 1,19] and 50% [95%CI: 0,20 - 1,03]. Disease-free survival was 65,4% [95%CI: 0,38 - 1,05], at 3 years, 57,7% [95%CI 0,323 - 0,952] at 5 years and 42,9% [95%CI 0,157 - 0,933], at 10 years. QoL analysis, through WHOQOL-BREF questionnaire, assessed at last available follow up revealed a mean score of 75,9 ± 11,6 on 100 points.
Despite no significant differences in survival between patients affected by Pancreatic or Extra-Pancreatic metastases, PM patients seems to show better outcome when managed surgically. mRCC patients, eligible for radical metastasectomy, tend to have long survival rates, reduced recurrence rates and good QoL.
This paper was registered retrospectively in ClinicalTrials.gov with Identification number: NCT03670992.
在靶向治疗时代，肾细胞癌（RCC）胰腺转移瘤（PM）的治疗仍是外科医生和肿瘤学家之间存在的一个问题。
回顾性分析26例接受RCC的PM及胰腺外转移瘤切除且意图达到R0切除的患者的数据。无人接受辅助化疗。患者分为两组；A组包括14例发生同步（5例）或异时性（9例）胰腺外转移瘤的患者。B组包括12例仅发生PM的患者。
未记录到术中死亡。14例患者（53.8%）发生并发症，根据Clavien-Dindo分类，除2例（7.26%）外均为I级和II级。8例患者（30.8%）复发，其中5例（62.5%）在其他部位接受了进一步切除。观察到的3年、5年和10年总生存率分别为88.5%[95%CI：0.56 - 1.33]、76.9%[95%CI：0.47 - 1.19]和50%[95%CI：0.20 - 1.03]。3年无病生存率为65.4%[95%CI：0.38 - 1.05]，5年为57.7%[95%CI 0.323 - 0.952]，10年为42.9%[95%CI 0.157 - 0.933]。通过WHOQOL-BREF问卷进行的生活质量分析，在最后一次可用随访时评估显示平均得分为75.9±11.6（满分100分）。
尽管胰腺转移或胰腺外转移患者的生存率无显著差异，但PM患者手术治疗时似乎预后更好。符合根治性转移瘤切除术的mRCC患者往往有较长的生存率、较低的复发率和良好的生活质量。
本文在ClinicalTrials.gov上进行了回顾性注册，识别号为：NCT03670992。
