Schütz Viktoria, Lin Huan, Kaczorowski Adam, Zschäbitz Stefanie, Jäger Dirk, Stenzinger Albrecht, Duensing Anette, Debus Jürgen, Hohenfellner Markus, Duensing Stefan
Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany.
Molecular Urooncology, Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 517, 69120 Heidelberg, Germany.
Cancers (Basel). 2023 Dec 6;15(24):5715. doi: 10.3390/cancers15245715.
Metastatic renal cell carcinoma (RCC) is among the most lethal urological malignancies. However, small, localized RCCs (≤7 cm, stage T1) have an excellent prognosis. There is a rare patient subgroup diagnosed with synchronous distant metastasis (T1N0M1), of which very little is known in terms of survival outcomes and underlying disease biology. Herein, we examined the long-term survival of 27 patients with clear cell RCC (ccRCC) stage T1N0M1 in comparison to 18 patients without metastases (T1N0M0). Tumor tissue was stained by immunohistochemistry for CD8+ tumor infiltrating lymphocytes (TILs). As expected, patients with stage T1N0M1 showed a significantly worse median cancer specific survival (CSS; 2.8 years) than patients with stage T1N0M0 (17.7 years; HR 0.077; 95% CI, 0.022-0.262). However, eight patients (29.6%) with ccRCC stage T1N0M1 survived over five years, and three of those patients (11.1%) survived over a decade. Some of these patients benefitted from an intensified, multimodal treatment including metastasis-directed therapy. The number of CD8+ TILs was substantially higher in stage T1N0M1 ccRCCs than in stage T1N0M0 ccRCCs, suggesting a more aggressive tumor biology. In conclusion, long-term survival is possible in patients with ccRCC stage T1N0M1, with some patients benefitting from an intensified, multimodal treatment approach.
转移性肾细胞癌（RCC）是最致命的泌尿系统恶性肿瘤之一。然而，小的局限性RCC（≤7 cm，T1期）预后良好。有一个罕见的患者亚组被诊断为同时性远处转移（T1N0M1），关于其生存结果和潜在疾病生物学知之甚少。在此，我们研究了27例T1N0M1期透明细胞RCC（ccRCC）患者与18例无转移患者（T1N0M0）的长期生存情况。通过免疫组织化学对肿瘤组织进行CD8 +肿瘤浸润淋巴细胞（TILs）染色。正如预期的那样，T1N0M1期患者的中位癌症特异性生存（CSS；2.8年）明显差于T1N0M0期患者（17.7年；HR 0.077；95% CI，0.022 - 0.262）。然而，8例（29.6%）T1N0M1期ccRCC患者存活超过5年，其中3例（11.1%）存活超过10年。这些患者中的一些受益于强化的多模式治疗，包括针对转移灶的治疗。T1N0M1期ccRCC中CD8 + TILs的数量显著高于T1N0M0期ccRCC，提示肿瘤生物学行为更具侵袭性。总之，T1N0M1期ccRCC患者有可能实现长期生存，一些患者受益于强化的多模式治疗方法。
