Dekernion J B, Ramming K P, Smith R B
J Urol. 1978 Aug;120(2):148-52. doi: 10.1016/s0022-5347(17)57082-2.
Survival factors of 86 patients with metastatic renal cell carcinoma were studied by computer analysis. Cumulative survival was 53 per cent at 6 months, 43 per cent at 1 year, 26 per cent at 2 years and 13 per cent at 5 years. Survival was influenced favorably by confinement of metastases to the lungs, by the absence of local recurrence or persistence of tumor and by a longer interval free of disease after removal of the primary tumor. Medical therapy improved survival during the first year after diagnosis of metastases but no objective regression of tumor was observed. Excision of metastatic foci significantly improved survival for up to 5 years (p less than 0.05 and p less than 0.02) after which most patients died of recurrence. Palliative or adjunctive nephrectomy in patients with metastases was associated with a 6 per cent mortality rate but it increases survival over other patients with metastases at the time of diagnosis of renal carcinoma who did not undergo nephrectomy. This difference was owing to patient selection and survival of those who had adjunctive nephrectomy was no greater than that of the study population as a whole. However, based on the factors that were associated with improved survival palliative nephrectomy may be beneficial when a limited number of metastases treatable by excision or radiation therapy are present, when effective systemic therapy exists or when the primary tumor produces severe symptoms.
通过计算机分析研究了86例转移性肾细胞癌患者的生存因素。6个月时累积生存率为53%，1年时为43%，2年时为26%，5年时为13%。转移局限于肺部、无局部复发或肿瘤持续存在以及原发肿瘤切除后无病间隔时间较长对生存有有利影响。在转移灶诊断后的第一年，药物治疗改善了生存率，但未观察到肿瘤的客观消退。转移灶切除在长达5年的时间里显著提高了生存率（p<0.05和p<0.02），此后大多数患者死于复发。转移性患者的姑息性或辅助性肾切除术死亡率为6%，但与未接受肾切除术的肾癌诊断时的其他转移性患者相比，其生存率有所提高。这种差异归因于患者选择，接受辅助性肾切除术患者的生存率并不高于整个研究人群。然而，基于与生存率提高相关的因素，当存在少量可通过切除或放射治疗的转移灶、存在有效的全身治疗或原发肿瘤产生严重症状时，姑息性肾切除术可能有益。
