Department of Surgery, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.
Department of Urology, Oulu University Hospital, PO Box 21, FI-90029 OYS, Oulu, Finland.
World J Surg Oncol. 2021 Jun 28;19(1):190. doi: 10.1186/s12957-021-02308-0.
The purpose of this study was to evaluate the effects of cytoreductive nephrectomy (CN) and metastasectomies on the survival of patients with synchronous metastatic renal cell cancer (mRCC) using real-life, population-based national dataset.
Nationwide data, including all cases of synchronous mRCC in Finland diagnosed on a 6-year timeframe, based on the Finnish Cancer Registry and complemented with patient records from the treating hospitals, were analyzed. Patients with Eastern Cooperative Oncology Group (ECOG) performance status 3-4 were excluded. Univariate and adjusted multivariable survival analysis were performed, including subgroup analysis for patients with different medical therapies. Nephrectomy complications were also analyzed.
A total of 732 patients were included in the analysis. CN was performed for 389 (53.1%) patients, whereas 68 (9.3%) patients underwent nephrectomy and metastasectomies of all lesions (surgery with curative intent). Median overall survival (OS) for patients who did not undergo nephrectomy was 5.9 (95% confidence interval [CI] = 4.6-7.2) months. Patients who had a CN had a median OS of 16.6 (95% CI = 14.2-19.1, p < 0.001) months, whereas patients who had surgery with curative intent had a median OS of 51.3 (95% CI = 36.0-66.6, p < 0.001) months. The survival benefit of CN and metastasectomies remained significant in all medical therapy subgroups and in both of the applied multivariable statistical models.
Surgical treatment of metastatic renal cell cancer is associated with a significant survival benefit in patients with good and moderate performance status, regardless of the chosen medical therapy.
本研究旨在使用真实的、基于人群的全国性数据集，评估细胞减灭性肾切除术（CN）和转移灶切除术对患有同步转移性肾细胞癌（mRCC）患者生存的影响。
根据芬兰癌症登记处，分析了在 6 年时间框架内诊断出的芬兰所有同步 mRCC 病例的全国性数据，并辅以治疗医院的患者记录。排除东部合作肿瘤学组（ECOG）表现状态为 3-4 的患者。进行了单变量和调整后的多变量生存分析，包括对不同医疗治疗患者的亚组分析。还分析了肾切除术并发症。
共纳入 732 例患者进行分析。389 例（53.1%）患者行 CN，68 例（9.3%）患者行所有病变的肾切除术和转移灶切除术（有治愈意图的手术）。未行肾切除术患者的中位总生存期（OS）为 5.9 个月（95%置信区间 [CI] = 4.6-7.2）。行 CN 的患者 OS 中位数为 16.6 个月（95% CI = 14.2-19.1，p < 0.001），而行有治愈意图的手术的患者 OS 中位数为 51.3 个月（95% CI = 36.0-66.6，p < 0.001）。CN 和转移灶切除术的生存获益在所有医疗治疗亚组和两种应用的多变量统计模型中均具有统计学意义。
在表现状态良好和中等的患者中，转移性肾细胞癌的手术治疗与显著的生存获益相关，无论选择何种医疗治疗。
