Kavolius J P, Mastorakos D P, Pavlovich C, Russo P, Burt M E, Brady M S
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
J Clin Oncol. 1998 Jun;16(6):2261-6. doi: 10.1200/JCO.1998.16.6.2261.
Resection of solitary metastases from renal cell carcinoma (RCC) is associated with a 5-year survival rate of 35% to 50%. Selection criteria are not well defined.
We retrospectively analyzed our experience with 278 patients with recurrent RCC from 1980 to 1993.
One hundred forty-one of 278 patients underwent a curative metastectomy for their first recurrence (44% 5-year overall survival [OS] rate), 70 patients underwent noncurative surgery (14% 5-year OS rate), and 67 patients were treated nonsurgically (11% 5-year OS rate). Favorable features for survival were a disease-free interval (DFI) greater than 12 months versus 12 months or less (55% v 9% 5-year OS rate; P < .0001), solitary versus multiple sites of metastases (54% v 29% 5-year OS rate; P < .001), and age younger than 60 years (49% v 35% 5-year OS rate; P < .05). Among 94 patients with a solitary metastasis, lung (n = 50; 54% 5-year OS rate) was more favorable than brain (n = 11; 18% 5-year OS rate; P < .05). Survival rates after curative resection of second and third metastases were not different compared with initial metastectomy (46% and 44%, respectively, v 43% 5-year OS rates; P = nonsignificant). Favorable predictors of survival by multivariate analysis included a single site of first recurrence, curative resection of first metastasis, a long DFI, a solitary site of first metastasis, and a metachronous presentation with recurrence.
Selected patients with recurrent RCC who can undergo a curative resection of their disease have a good opportunity for long-term survival, particularly those with a single site of recurrence and/or a long DFI.
肾细胞癌（RCC）孤立性转移灶切除术的5年生存率为35%至50%。选择标准尚不明确。
我们回顾性分析了1980年至1993年间278例复发性RCC患者的治疗经验。
278例患者中，141例因首次复发接受了根治性转移灶切除术（5年总生存率[OS]为44%），70例接受了非根治性手术（5年OS率为14%），67例接受了非手术治疗（5年OS率为11%）。生存的有利因素包括无病间期（DFI）大于12个月与12个月或更短（5年OS率分别为55%对9%；P<.0001）、孤立性转移灶与多发性转移灶（5年OS率分别为54%对29%；P<.001）以及年龄小于60岁（5年OS率分别为49%对35%；P<.05）。在94例孤立性转移患者中，肺部转移（n = 50；5年OS率为54%）比脑部转移（n = 11；5年OS率为18%；P<.05）更有利。与初次转移灶切除术相比，二次和三次转移灶根治性切除术后的生存率无差异（5年OS率分别为46%和44%对43%；P无统计学意义）。多变量分析中生存的有利预测因素包括首次复发的单一部位、首次转移灶的根治性切除、较长的DFI、首次转移灶的孤立部位以及复发的异时性表现。
部分能够接受疾病根治性切除的复发性RCC患者有长期生存的良好机会，尤其是那些复发部位单一和/或DFI较长的患者。
