转移性肾细胞癌靶向药物治疗长期疗效观察

Long-term efficacy of the targeted therapies for metastatic renal cell carcinoma

目的分子靶向药物具有抗血管生成及抗肿瘤的双重作用,文中旨在探讨靶向药物舒尼替尼对转移性肾细胞癌(metastatic renal cell carcinoma,mRCC)的长期疗效和不良反应。方法选择2007年11月至2013年3月收治的281例mRCC患者并根据是否自愿进行治疗分为2组。实验组(接受舒尼替尼50 mg/d口服)102例,比较实验组舒尼替尼治疗前后疼痛评分、转移可测量病灶的变化等,进行疗效评估及不良反应分析。对照组(拒绝接受该方案而采用免疫治疗)179例。比较2组临床资料差异,Kaplan-Meier绘制生存曲线,采用Cox回归模型进行多因素分析。结果实验组透明细胞癌患者缓解率29.4%,稳定率53.8%,总有效率83.2%;乳头状肾癌15例,治疗后缓解率33.3%,稳定率46.7%,总有效率80.0%;集合管肾癌9例治疗后缓解率22.2%,稳定率55.6%,总有效率77.8%。1个周期治疗方案骨扫描显示,进展2例(10.5%),缓解5例(26.3%),稳定例数为12例(63.2%),骨转移治疗总有效率89.5%、实验组1个周期治疗结束后,肺转移有效率81.7%;肝转移患者总有效率60.0%;淋巴结转移患者总有效率72.8%。实验组中位总生存期为28.9个月,对照组为20.7个月,组间差异有统计学意义(P﹤0.05)。Cox回归分析显示年龄、肿瘤分型和肝、肺、骨及淋巴结转移是影响mRCC的预后独立因素。不良反应主要为白细胞、血小板减少,中性粒细胞减少,低蛋白血症。结论靶向药物舒尼替尼使患者转移灶减少或缩小、疼痛减轻,改善生活质量,抑制mRCC的进展,总生存期延长。

Objective Molecular targeted drugs have anti-angiogenesis and anti-tumor effects.The study was to investigate the role of sunitinib on treating metastatic renal cell carcinoma （ mRCC） and its long-term efficacy and adverse reactions. Methods From November 2007 to March 2013, 281 mRCC patients were divided into two groups according to their own willingness.102 patients in the experimental group received sunitinib 50 mg per day.Pain score, metastatic focuses before and after targeted therapies were compared.179 patients in control group was treated by immunotherapy.Kaplan-Meier survival analysis was used to draw the survival curves and Cox regression model was applied in multivariate analysis. Results There was no difference between the two groups on baseline （P〉0.05）.In the experimental group, 78 cases were clear cell carcinoma, with remission rate 29.4%, stablity rate 53.8%and total effective rate 83.2%after treatment;15 cases were papillary renal cell carcinoma, with remission rate 33.3%, stablity ratio 46.7%and total effective rate 80.0% after treatment;9 cases were collecting duct carcinoma, with the remission rate 22.2%, the＆nbsp;stablity ratio 55.6% and the total effective rate 77.8% after treatment.The bone scan after 1 cycle of treatment showed 2 cases progressed（10.5%）, 5 cases relieved（26.3%） and 12 cases sta-blized（63.2%）, the total effective rate of bone metastasis amounting to 89.5%, the effective rate of lung metastasis 81.7%, the effective＆nbsp;rate of liver metastasis 60.0%and the effective rate of lymph node metastasis 72.8%.The median overall survival in the experimental group was 28.9 months, 20.7 months in control group（P〈0.05）.Cox regression analysis showed age, tumor classification, liver, lung, bone and lymph node metastasis were prognostic factors influencing mRCC.The common averse events were white blood cells, thrombocytopenia, neutropenia and hypoalbuminemia. Conclusion Sunitinib for the treatment of mRCC can diminish the metastatic focuses , ease the pain , improve the quality of life, delay the progression of the disease, and prolong the overall survival.