细胞减灭性肾切除术和全身治疗在转移性肾细胞癌患者肿瘤血栓管理中的作用。
The role of cytoreductive nephrectomy and systemic therapy in the management of tumour thrombus in patients with metastatic renal cell carcinoma.
机构信息
Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
出版信息
Br J Cancer. 2023 May;128(10):1888-1896. doi: 10.1038/s41416-023-02166-5. Epub 2023 Mar 1.
BACKGROUND
Outcomes for patients with metastatic renal cell carcinoma (mRCC) and tumour thrombus remain poor. Recent data suggest limited role for cytoreductive nephrectomy (CN) and data on thrombus response to systemic therapy (ST) is scarce. Here, we describe response and survival of patients with de novo mRCC and thrombi treated with ST with or without CN.
METHODS
Demographics, disease characteristics and survival of patients with de novo mRCC were collected. Progression-free survival (PFS) and overall survival (OS) in months (m) was calculated using the Kaplan-Meier method (log-rank).
RESULTS
Between 2002 and 2019, 226 patients with mRCC were identified, 64 (28.3%) had tumour thrombus out of which 18 (28.1%) received only ST. Among 12 evaluable patients, thrombus response, stability and progression were seen in 3 (25%), 6 (50%) and 3 (25%) patients, respectively. Median OS was similar for patients with and without tumour thrombus treated with systemic therapy alone [OS: 12.1 m (8.8-27.7) vs. 13.9 m (7.9-21.5), p = 0.87]. CN predicted for better OS in patients with tumour thrombus [OS: 29.4 m (17.4-48.9) vs. 12.1 m (8.8-27.7), p = 0.01].
CONCLUSION
In this retrospective series of patients with mRCC and tumour thrombus, addition of CN to ST improved outcomes. Validation of these findings with contemporary regimens is needed.
背景
转移性肾细胞癌（mRCC）患者和肿瘤血栓的预后仍然较差。最近的数据表明，细胞减瘤性肾切除术（CN）的作用有限，关于血栓对全身治疗（ST）的反应的数据也很少。在这里，我们描述了接受 ST 治疗或不接受 CN 治疗的初发 mRCC 和血栓患者的反应和生存情况。
方法
收集了初发 mRCC 患者的人口统计学、疾病特征和生存数据。使用 Kaplan-Meier 方法（对数秩检验）计算无进展生存期（PFS）和总生存期（OS）。
结果
在 2002 年至 2019 年间，共确定了 226 例 mRCC 患者，其中 64 例（28.3%）有肿瘤血栓，其中 18 例（28.1%）仅接受 ST 治疗。在 12 例可评估患者中，分别有 3 例（25%）、6 例（50%）和 3 例（25%）患者出现血栓反应、稳定和进展。单独接受系统治疗的有和没有肿瘤血栓的患者的中位 OS 相似[OS：12.1 m（8.8-27.7）与 13.9 m（7.9-21.5），p=0.87]。CN 预测有肿瘤血栓的患者的 OS 更好[OS：29.4 m（17.4-48.9）与 12.1 m（8.8-27.7），p=0.01]。
结论
在这项回顾性系列研究中，初发 mRCC 患者和肿瘤血栓患者中，CN 联合 ST 治疗改善了预后。需要用当代方案来验证这些发现。
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