Magan Tejal, Pradeep Tejus, Tuluc Madalina, Bilyk Jurij R, Milman Tatyana
Department of Pathology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA.
Department of Pathology, Anatomy, and Cell Biology, Jefferson University Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA.
Saudi J Ophthalmol. 2022 Apr 18;35(3):209-216. doi: 10.4103/SJOPT.SJOPT_96_21. eCollection 2021 Jul-Sep.
The purpose of this study was to review the clinical presentation, systemic work-up, and outcomes of all previously reported ocular adnexal (OA) metastases from renal cell carcinoma (RCC).
This was a literature review. PubMed and Google Scholar databases were searched for all well-documented cases of OA metastases from RCC.
Final analysis identified 44 patients with either biopsy-confirmed (41/44, 93%) or treatment response-documented (3/44, 6%) OA metastases from RCC. Thirty-four (77%) patients were male. The median age was 60 years (mean: 60, range: 22-87 years). The most common presenting signs were proptosis (19/44, 43%) and OA mass (14/44, 32%). Metastases most frequently involved the orbital bones (10/44, 23%) and adjacent extraconal fat, extending from the sinonasal tract in 7/10 (70%) of these cases. OA metastases were initial manifestation of RCC in 18/44 (41%) patients. At the time of primary tumor diagnosis, 22 of 30 (73%) patients had American Joint Committee on Cancer Stage IV disease with metastases to 2 or more sites in 13 (57%) patients. Seventeen of 42 (40%) patients underwent local therapy only, which most commonly included excision/exenteration with margin control (10/17, 59%). Twenty-five of 42 (60%) patients had systemic therapy, which included biologic agents and chemotherapy. The absolute 5-year survival rate was 66% with significantly improved survival in patients reported after 2006 (92% vs. 42%, = 0.04) and in those with isolated OA metastases (100% vs. 27%, = 0.02) at 30 months.
Although RCC metastases to OA occur in a setting of advanced disease, the recent advances in diagnostic modalities and targeted therapies resulted in improved survival.
本研究旨在回顾既往报道的所有肾细胞癌（RCC）眼附属器（OA）转移的临床表现、全身检查及治疗结果。
这是一项文献综述。通过检索PubMed和谷歌学术数据库，查找所有记录完整的RCC眼附属器转移病例。
最终分析确定了44例经活检证实（41/44，93%）或有治疗反应记录（3/44，6%）的RCC眼附属器转移患者。34例（77%）患者为男性。中位年龄为60岁（平均：60岁，范围：22 - 87岁）。最常见的临床表现为眼球突出（19/44，43%）和眼附属器肿物（14/44，32%）。转移最常累及眶骨（10/44，23%）及相邻的眶外脂肪，其中7/10（70%）的病例起源于鼻窦。18/44（41%）的患者眼附属器转移是RCC的首发表现。在原发性肿瘤诊断时，30例患者中有22例（73%）为美国癌症联合委员会IV期疾病，其中13例（57%）转移至2个或更多部位。42例患者中有17例（40%）仅接受了局部治疗，最常见的是行切除/眶内容剜除术并确保切缘阴性（10/17，59%）。42例患者中有25例（60%）接受了全身治疗，包括生物制剂和化疗。5年绝对生存率为66%，2006年后报道的患者生存率显著提高（92%对42%，P = 0.04），30个月时孤立性眼附属器转移患者的生存率也显著提高（100%对27%，P = 0.02）。
尽管RCC转移至眼附属器多发生于疾病晚期，但诊断方法和靶向治疗的最新进展使生存率有所提高。
