Wu J, Caliendo G, Hu X P, Dutcher J P
Department of Oncology, Montefiore Medical Centre, Bronx, New York 10467, USA.
Med Oncol. 1998 Apr;15(1):44-9. doi: 10.1007/BF02787344.
Among 107 renal cell carcinoma (RCC) patients with histopathologic subtype diagnosis who were treated at Albert Einstein Cancer Center with cytokines over a 10-year period, seven patients had sarcomatoid histology, 63 had clear cell carcinoma, and 10 patients had mixed histology (sarcomatoid and clear cell). Regardless of their histology, patients with a disease free interval of 2 years or more had significantly better survival. None of the patients with sarcomatoid histology responded to therapy. However, several patients with mixed and clear cell histology achieved partial or complete responses following high dose Interleukin-2 (IL-2) therapy. The median survival of patients with sarcomatoid histology was the shortest (13.8 months), whilst that of patients with mixed and clear cell histology was much longer (34.8 months and 39.1 months, respectively). This result was statistically significant in both univariate and multivariate survival analysis (P < 0.001 and P < 0.01, respectively). Patients with mixed and clear cell histology had no significant difference in survival, and their median survival combined was significantly longer than that of patients with sarcomatoid histology (P < 0.0001 in univariate analysis, P < 0.01 in multivariate analysis). This study suggests that survival with a diagnosis of RCC is predicted by tumor histology and disease free interval, and this impacts on the ability to respond to standard therapy. Patients with mixed and clear cell histology respond to cytokine therapy. Other therapies should be sought for patients with sarcomatoid RCC.
在阿尔伯特·爱因斯坦癌症中心接受细胞因子治疗长达10年的107例有组织病理学亚型诊断的肾细胞癌（RCC）患者中，7例为肉瘤样组织学，63例为透明细胞癌，10例为混合组织学（肉瘤样和透明细胞）。无论组织学类型如何，无病生存期达2年或更长时间的患者生存率显著更高。肉瘤样组织学的患者均对治疗无反应。然而，一些混合组织学和透明细胞组织学的患者在接受高剂量白细胞介素-2（IL-2）治疗后实现了部分或完全缓解。肉瘤样组织学患者的中位生存期最短（13.8个月），而混合组织学和透明细胞组织学患者的中位生存期则长得多（分别为34.8个月和39.1个月）。在单因素和多因素生存分析中，这一结果均具有统计学意义（分别为P < 0.001和P < 0.01）。混合组织学和透明细胞组织学的患者在生存率上无显著差异，且他们的联合中位生存期显著长于肉瘤样组织学的患者（单因素分析中P < 0.0001，多因素分析中P < 0.01）。本研究表明，RCC诊断后的生存率可通过肿瘤组织学和无病生存期预测，且这会影响对标准治疗的反应能力。混合组织学和透明细胞组织学的患者对细胞因子治疗有反应。对于肉瘤样RCC患者应寻求其他治疗方法。
