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Effect of Surgical Resection of Isolated Metastasis from Renal Cell Carcinoma after Targeted Therapy
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摘要:
目的 探讨靶向药物治疗的转移性肾细胞癌患者远处孤立转移病灶行手术切除的疗效。 方法 回顾性收集2007年12月至2013年12月在北京协和医院接受靶向药物治疗的126例转移性肾细胞癌患者资料, 其中16例对远处孤立转移灶予以手术切除。患者均有明确的肾细胞癌病理诊断, 口服靶向药物索拉非尼、舒尼替尼或依维莫司, 直至孤立转移灶稳定且评估为可切除。对手术治疗的安全性和远期效果进行评价。 结果 接受远处孤立转移灶切除术的16例患者中, 男11例, 女5例, 中位年龄51岁(37~72岁); 其中肾透明细胞癌14例, 肾乳头状细胞癌2例; 肺转移5例, 骨转移2例, 肾上腺转移5例, 脑转移2例, 肝转移1例, 腹壁转移1例。患者围术期均恢复良好, 无严重并发症发生。术后肿瘤相关症状明显缓解, 一般情况有所好转。16例患者1、3、5年生存率分别为75.0%、43.8%和31.3%。无手术相关的死亡。 结论 经靶向药物治疗的晚期肾细胞癌患者有远处孤立转移灶时可从手术治疗中获益, 取得较长时间生存。 Abstract:Objective To evaluate the effect of surgical resection of isolated metastases in patients with advanced renal cell carcinoma after targeted therapy. Methods Data were retrospectively collected from 126 patients with metastatic renal cell carcinoma who received targeted therapy in Peking Union Medical College Hospital between December 2007 to December 2013, of whom 16 underwent surgery for distant isolated metastases. All the patients had a confirmed pathological diagnosis of renal cell carcinoma. The targeted therapy involved taking oral drugs including Sorafenib, Sutent, or Everolimus continuously until the isolated metastases were evaluated as stable and resectable. Safety and long-term effect of surgical resection were evaluated. Results The 16 patients included 11 males and 5 females with a median age of 51 (37-72) years. Fourteen cases were renal clear cell carcinomas and 2 were renal papillary cell carcinomas; lung metastasis was found in 5 cases, bone metastasis in 2 cases, adrenal metastasis in 5 cases, brain metastasis in 2 cases, liver metastasis in 1 case, and abdominal wall metastasis in 1 case. In the perioperative period, all the patients recovered well without serious complications. Tumor-related symptoms were relieved after the surgery and the general situation was improved. The 1-, 3-, and 5-year survival of the 16 patients were 75.0%, 43.8%, and 31.3%, respectively. There was no surgery-related mortality. Conclusion Patients with renal cell carcinoma treated with targeted therapy who develop distant isolated metastases may benefit from surgical resection of the metastases, achieving reasonable long-term survival. -
Key words:
- renal cell carcinoma /
- isolated metastasis /
- surgical resection /
- long-term survival
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图 1 肾细胞癌肺转移患者靶向药物治疗后肺孤立转移病灶切除前胸部CT
A.2009年6月24日，肾癌根治术后19个月胸部CT提示双肺结节增大；B.2010年1月21日，术后26个月，行靶向药物治疗7个月，双肺结节减小；C.2012年11月16日，术后60个月，持续靶向药物治疗，双肺结节进一步减小，强化减低
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