Department of Urology, Chinese PLA General Hospital, Beijing, China.
Department of Urology, Chinese PLA General Hospital, Beijing, China.
Crit Rev Oncol Hematol. 2024 Apr;196:104316. doi: 10.1016/j.critrevonc.2024.104316. Epub 2024 Mar 2.
To evaluate the efficacy, feasibility and safety of neoadjuvant therapy (NAT) for renal cell carcinoma with tumor thrombus (RCC-TT) in terms of response, perioperative and oncological outcomes, and compare the results between neoadjuvant and non-neoadjuvant groups. Overall, 29 single-arm studies and 5 cohort studies were included. Of the 204 patients undergoing NAT, 16.2% were level I, 35.3% level II, 24.0% level III and 18.6% level IV thrombus. Most of patients underwent preoperative targeted therapy, immunotherapy-based combination therapy was applied in 5.4% patients. The total reduction rate of thrombus level was 29.4%. NAT is associated with a shorter operative time, less blood loss (p<0.05 for both). Rate of complications and oncological outcomes were similar between two groups. Overall, 32.1% (34/106) ≥ grade 3 adverse events occurred in patients undergoing NAT. Neoadjuvant therapy is safe and feasible with acceptable perioperative outcomes in RCC-TT.
为了评估新辅助治疗（NAT）在反应、围手术期和肿瘤学结果方面对肾细胞癌伴肿瘤栓子（RCC-TT）的疗效、可行性和安全性，并比较新辅助组和非新辅助组的结果，我们总体上纳入了 29 项单臂研究和 5 项队列研究。在接受 NAT 的 204 例患者中，16.2%为 I 级，35.3%为 II 级，24.0%为 III 级，18.6%为 IV 级血栓。大多数患者接受了术前靶向治疗，5.4%的患者接受了基于免疫疗法的联合治疗。血栓水平的总缓解率为 29.4%。NAT 与手术时间更短、出血量更少相关（两者均<0.05）。两组并发症和肿瘤学结果相似。总体而言，32.1%（34/106）接受 NAT 的患者发生≥3 级不良事件。NAT 在 RCC-TT 中具有可接受的围手术期结果，是安全可行的。
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