初治晚期肾细胞癌行巩固性肾切除术的结果：一项多中心分析。
Outcomes of Consolidative Nephrectomy following Primary Immunotherapy in Advanced Renal Cell Carcinoma: A Multicenter Analysis.
机构信息
Department of Urology, UC San Diego School of Medicine, San Diego, CA.
Deparment of Internal Medicine, Division of Hematology and Medical Oncology, UC San Diego School of Medicine, San Diego, CA.
出版信息
Clin Genitourin Cancer. 2023 Dec;21(6):694-702. doi: 10.1016/j.clgc.2023.07.007. Epub 2023 Jul 19.
BACKGROUND
To evaluate effect and outcomes of combination primary immunotherapy (IO) and nephrectomy for advanced renal cell carcinoma (RCC).
METHODS
We conducted a multicenter, retrospective analysis of patients with advanced/metastatic RCC who received IO followed by nephrectomy. Primary outcome was Bifecta (negative surgical margins and no 30-day surgical complications). Secondary outcomes included progression-free survival (PFS) following surgery, reduction in tumor/thrombus size, RENAL score, and clinical/pathologic downstaging. Cox regression multivariable analysis was conducted for predictors of Bifecta and PFS. Kaplan-Meier analysis assessed PFS, comparing Bifecta and non-Bifecta groups.
RESULTS
A total of 56 patients were analyzed (median age 63 years; median follow-up 22.5 months). A total of 40 (71.4%) patients were intermediate IMDC risk. Patients were treated with immunotherapy for median duration of 8.1 months. Immunotherapy resulted in reductions in tumor size (P < .001), thrombus size (P = .02), and RENAL score (P < .001); 38 (67.9%) patients were clinically downstaged on imaging (P < .001) and 25 (44.6%) patients were pathologically downstaged following surgery (P < .001). Bifecta was achieved in 38 (67.9%) patients. Predictors for bifecta achievement included decreasing tumor size (HR 1.08, P = .043) and pathological downstaging (HR 2.13, P = .047). Bifecta (HR 5.65, P = .009), pathologic downstaging (HR 5.15, P = .02), and increasing reduction in tumor size (HR 1.2, P = .007) were associated with improved PFS. Bifecta patients demonstrated improved 2-year PFS (84% vs. 71%, P = .019).
CONCLUSIONS
Primary immunotherapy reduced tumor/thrombus size and complexity. Pathologically downstaged patients were more likely to achieve bifecta, and these patients displayed improved 2-year PFS. Our study supports further inquiry in the use of CRN following primary immunotherapy for advanced renal cancer.
背景
评估联合初始免疫治疗（IO）和肾切除术治疗晚期肾细胞癌（RCC）的疗效和结果。
方法
我们对接受 IO 后行肾切除术的晚期/转移性 RCC 患者进行了多中心回顾性分析。主要结局为 Bifecta（无手术切缘阳性和 30 天手术并发症）。次要结局包括手术后无进展生存期（PFS）、肿瘤/血栓大小缩小、RENAL 评分以及临床/病理降期。采用 Cox 回归多变量分析预测 Bifecta 和 PFS 的因素。Kaplan-Meier 分析比较了 Bifecta 和非 Bifecta 组的 PFS。
结果
共分析了 56 例患者（中位年龄 63 岁；中位随访时间 22.5 个月）。40 例（71.4%）患者为中间 IMDC 风险。患者接受 IO 治疗的中位时间为 8.1 个月。免疫治疗导致肿瘤大小（P<0.001）、血栓大小（P=0.02）和 RENAL 评分（P<0.001）缩小；38 例（67.9%）患者影像学上临床降期（P<0.001），25 例（44.6%）患者术后病理降期（P<0.001）。38 例（67.9%）患者达到 Bifecta。达到 Bifecta 的预测因素包括肿瘤大小缩小（HR 1.08，P=0.043）和病理降期（HR 2.13，P=0.047）。Bifecta（HR 5.65，P=0.009）、病理降期（HR 5.15，P=0.02）和肿瘤大小缩小（HR 1.2，P=0.007）与 PFS 改善相关。Bifecta 患者的 2 年 PFS 改善（84% vs. 71%，P=0.019）。
结论
初始免疫治疗降低了肿瘤/血栓的大小和复杂性。病理降期的患者更有可能达到 Bifecta，这些患者显示出 2 年 PFS 的改善。我们的研究支持在晚期肾癌的初始免疫治疗后进一步研究 CRN 的应用。
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