Levy D A, Swanson D A, Slaton J W, Ellerhorst J, Dinney C P
Department of Urology, University of Texas M. D. Anderson Cancer Center, Houston 77030, USA.
J Urol. 1998 Apr;159(4):1168-73.
We determine whether cytoreductive surgery delays or precludes the administration of systemic biological therapy in patients with previously untreated metastatic renal cell carcinoma.
We evaluated 79 patients 22 to 73 years old with untreated renal cell carcinoma for possible cytoreductive surgery before the administration of systemic biological therapy. Based on performance status, overall disease burden and subjective clinical assessment 13 patients were referred for initial systemic biological therapy and 66 underwent cytoreductive surgery as initial treatment. We evaluated patient ability to receive postoperative biological therapy, time to therapy, surgical complications and mortality.
Cytoreductive surgery had a minimal impact on the administration of timely systemic biological therapy in these carefully selected patients. Of the 66 patients 54 (82%) received postoperative systemic biological therapy beginning a median of 40 days after nephrectomy. Two patients (3%) died postoperatively (within 30 days) and in 1 (1.5%) postoperative deterioration in performance status precluded the administration of systemic therapy. The other 9 patients did not have measurable residual disease postoperatively, did not need or refused systemic therapy, or were followed elsewhere.
Systemic biological therapy can be administered in a timely manner (median 40 days) to the majority of patients (82% treated) after cytoreductive surgery. Surgery alone does not preclude the administration of systemic biological therapy in carefully selected patients.
我们确定减瘤手术是否会延迟或妨碍对先前未经治疗的转移性肾细胞癌患者进行全身生物治疗。
我们评估了79例年龄在22至73岁之间、未经治疗的肾细胞癌患者，在进行全身生物治疗之前是否可能进行减瘤手术。根据体能状态、总体疾病负担和主观临床评估，13例患者被转诊接受初始全身生物治疗，66例患者接受了减瘤手术作为初始治疗。我们评估了患者接受术后生物治疗的能力、治疗时间、手术并发症和死亡率。
在这些经过精心挑选的患者中，减瘤手术对及时进行全身生物治疗的影响极小。66例患者中，54例（82%）在肾切除术后中位数40天开始接受术后全身生物治疗。2例患者（3%）术后死亡（30天内），1例（1.5%）术后体能状态恶化妨碍了全身治疗的进行。其他9例患者术后没有可测量的残留疾病，不需要或拒绝全身治疗，或在其他地方接受随访。
对于大多数接受减瘤手术的患者（82%接受治疗），全身生物治疗可以及时进行（中位数40天）。在精心挑选的患者中，单纯手术并不妨碍进行全身生物治疗。
