Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan.
Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Cancer Sci. 2021 Jun;112(6):2416-2425. doi: 10.1111/cas.14902. Epub 2021 May 1.
The efficacy of surgical resection in metastatic renal cell carcinoma is an active and important research field in the postcytokine era. Bone metastases, especially in the spine, compromise patient performance status. Metastasectomy is indicated, if feasible, because it helps to achieve the best clinical outcomes possible compared with other treatments. This study examined the postoperative survival and prognostic factors in patients who underwent metastasectomy of spinal lesions. The retrospective study included 65 consecutive patients with metastatic renal cell carcinomas who were operated on by spinal metastasectomy between 1995 and 2017 at our institution. The cancer-specific survival times from the first spinal metastasectomy to death or the last follow-up (≥3 years) were determined using Kaplan-Meier analysis. Potential factors influencing survival were analyzed using Cox proportional hazard models. Planned surgical resection of all the spine tumors was achieved in all patients. Of these, 38 had complete metastasectomy of all visible metastases, including extraspinal lesions. In all patients, the estimated median cancer-specific survival time was 100 months. The 3-, 5-, and 10-year cancer-specific survival rates were 77%, 62%, and 48%, respectively. The survival times after spinal metastasectomy were similar in both cytokine and postcytokine groups. In multivariate analyses, postoperative disability, the coexistence of liver metastases, multiple spinal metastases, and incomplete metastasectomy were significant risk factors associated with short-term survival. Complete metastasectomy, including extraspinal metastases, was associated with improved cancer-specific survival. Proper patient selection and complete metastasectomy provide a better prognosis in metastatic renal cell carcinoma patients.
在细胞因子时代后，外科手术切除转移性肾细胞癌的疗效是一个活跃且重要的研究领域。骨转移，尤其是脊柱转移，会降低患者的身体状况。如果可行，转移切除术是有指征的，因为与其他治疗方法相比，它有助于实现最佳的临床效果。本研究探讨了接受脊柱转移切除术患者的术后生存和预后因素。这项回顾性研究纳入了 1995 年至 2017 年在我院接受脊柱转移切除术的 65 例连续转移性肾细胞癌患者。通过 Kaplan-Meier 分析确定了首次脊柱转移切除术后至死亡或最后一次随访（≥3 年）的癌症特异性生存时间。使用 Cox 比例风险模型分析潜在的影响生存的因素。所有患者均实现了所有脊柱肿瘤的计划性手术切除，其中 38 例患者完全切除了所有可见转移灶，包括脊柱外转移灶。所有患者的估计中位癌症特异性生存时间为 100 个月。3、5 和 10 年的癌症特异性生存率分别为 77%、62%和 48%。细胞因子和细胞因子后组的脊柱转移术后生存时间相似。多因素分析显示，术后残疾、肝转移共存、多发脊柱转移和不完全转移切除术是与短期生存相关的显著危险因素。包括脊柱外转移在内的完全转移切除术与改善的癌症特异性生存相关。适当的患者选择和完全的转移切除术为转移性肾细胞癌患者提供了更好的预后。
