Maelle Rony, Jean-Philippe Ratone, Jochen Walz, Geraldine Pignot, Fabrice Caillol, Christian Pesenti, Mathilde Guerin, Slimane Dermeche, Serge Brunelle, Naji Salem, Cecile Vicier, Stanislas Rybikowski, Thomas Maubon, Sami Fakhfakh, Manuel Tejeda, Marc Giovannini, Gwenaelle Gravis
Paoli-Calmettes Institute, Department of Gastrointestinal Disease, Marseille, France.
Paoli-Calmettes Institute, Department of Urology, Marseille, France.
Front Oncol. 2021 Mar 23;11:644301. doi: 10.3389/fonc.2021.644301. eCollection 2021.
Digestive metastases (DMs) from renal cell cancer (RCC) are rare. Over the past decade, the overall survival of metastatic RCC (mRCC) has been improved by tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors. The main objective of this study was to assess the incidence of metastases of the digestive tract in this new field of treatment. The secondary objectives were to evaluate the clinical characteristics, prognosis, treatments used for DMs, and median time between the diagnosis of RCC or mRCC and DMs. A retrospective analysis of data collected from all patients with mRCC between 2007 (the time of TKI was a standard of care) and 2019 was carried out at the Paoli-Calmettes Institute (Marseille, France). Computer research software using artificial intelligence (ConSoRe®) was used to identify patients and assess their characteristics. Between January 2007 and December 2019, 11 out of 660 (1.6%) mRCC patients had metastases of the gastrointestinal tract. The median age was 62 years. Of the 11 patients, 81.8% experienced digestive bleeding or anemia. Only 2 patients were asymptomatic. The metastases were mainly duodenal (50%) and gastric (41.6%). The median time from cancer diagnosis and from metastatic disease to gastrointestinal metastasis was 4.3 years (3 months-19.2 years) and 2.25 years (0 days-10.2 years), respectively. Local treatment was performed in 38.5% of cases by endoscopy (60%), surgery (20%) and radiotherapy (40%) with success rates of 33, 100, and 50%, respectively. Etiological treatment was modified following the discovery of DM in 84.6% of the cases. The median survival was 1 year from the diagnosis of DM (13 days-9.4 years). Two patients were still alive 2.9 and 9.4 years after the diagnosis of DM. This is the largest monocentric retrospective analysis of DM in patients with RCC. It seems to be a rare and late event in the course of the disease. Local treatment combined with systemic treatment could improve survival. In the context of prolonged survival with the new based immunotherapy treatments in mRCC, we suggest that unexplained anemia or persistent digestive symptoms could be explored by endoscopy.
肾细胞癌（RCC）的消化道转移（DMs）较为罕见。在过去十年中，酪氨酸激酶抑制剂（TKIs）和免疫检查点抑制剂改善了转移性肾细胞癌（mRCC）的总生存率。本研究的主要目的是评估在这个新的治疗领域中消化道转移的发生率。次要目的是评估DMs的临床特征、预后、治疗方法，以及RCC或mRCC诊断与DMs之间的中位时间。在法国马赛的保利 - 卡尔梅特研究所，对2007年（TKI成为标准治疗方法的时间）至2019年间所有mRCC患者收集的数据进行了回顾性分析。使用人工智能计算机研究软件（ConSoRe®）来识别患者并评估其特征。2007年1月至2019年12月期间，660例mRCC患者中有11例（1.6%）发生了胃肠道转移。中位年龄为62岁。在这11例患者中，81.8%出现了消化道出血或贫血。只有2例患者无症状。转移主要发生在十二指肠（50%）和胃（41.6%）。从癌症诊断到胃肠道转移以及从转移性疾病到胃肠道转移的中位时间分别为4.3年（3个月 - 19.2年）和2.25年（0天 - 10.2年）。38.5%的病例进行了局部治疗，其中内镜治疗（占60%）、手术（占20%）和放疗（占40%），成功率分别为33%、100%和50%。84.6%的病例在发现DMs后改变了病因治疗。从DMs诊断起的中位生存期为1年（13天 - 9.4年）。两名患者在DMs诊断后2.9年和9.4年仍然存活。这是对RCC患者DMs进行的最大规模单中心回顾性分析。这似乎是疾病过程中一种罕见且较晚出现的事件。局部治疗联合全身治疗可能会提高生存率。在mRCC新型免疫治疗延长生存期的背景下，我们建议对于不明原因的贫血或持续的消化道症状可通过内镜检查进行探究。
