肾癌术后辅助性免疫治疗临床疗效评价

Role of Immunotherapy after Nephrectomy for Renal Cell Carcinoma

目的:观察免疫治疗对肾癌术后患者远期复发及转移的预防作用,分析免疫治疗对肾癌术后患者预后的影响。方法:对2000年1月至2005年12月根治性肾切除术后病理诊断为肾细胞癌的298例病例进行回顾性研究,术前影像学未见局部淋巴结及远处转移。分析患者临床特征及免疫治疗与无进展生存时间及总生存时间的关系。结果:根活性肾切除术后接受IFNα-2a治疗的70例患者5年无进展生存率及总生存率分别为90.0%和91.4%;接受LAK细胞治疗的109例患者5年无进展生存率及总生存率分别为83.5%和89.9%;而术后未接受任何治疗的119例患者5年无进展生存率和5年总生存率分别为68.1%和76.5%,有显著性差异。单因素分析免疫治疗为无进展生存时间和总生存时间影响因素;多因素分析显示,免疫治疗可作为肾癌独立的预后因素。结论:根治性肾切除术后辅助性免疫治疗可以降低国内肾癌患者术后复发转移风险,延长生存时间。

Objective： To evaluate the association of immunotherapy with the clinicopathologic parameters, disease-free survival, and overall survival of patients with renal cell carcinoma. Methods： A total of 298 patients with renal cell carcinoma who underwent radical nephrectomy of at Tianjin Medical University Cancer Institute and Hospital between January 2000 and December 2005 were ret- rospectively studied. Of all the 298 cases of renal cell carcinoma, preoperative imaging showed no regional lymph node or distant me- tastasis. Univariate and multivariate analyses were used to determine the association between immunotherapy and survival. Results： The 5-year disease-free and 5-year survival rates of patients who received IFNct-2a （ 90.0 % and 91.4 %） and LAK cell therapy （ 83.5 % and 89.9 %） after radical nephrectomy were found to be significantly higher than those of the patients who did not receive such treatments （ 68.1% and 76.5 % ）. In the univariate analysis, immunotherapy was found to be associated with disease-free and overall survival time. A multivariable Cox regression model revealed immunotherapy as an independent predictor of renal cell carcinoma. Con- clusion： Immunotherapy after radical nephrectomy could reduce the risk of recurrence and metastasis, as well as prolong overall surviv- al time in renal cell carcinoma patients. x