靶向药物治疗肾细胞癌合并下腔静脉癌栓的初步经验

Preliminary experience of targeted therapy for advanced renal cell carcinoma combined with inferior vena cava cancer embolus

目的探讨靶向药物治疗肾细胞癌(RCC)合并下腔静脉癌栓的可行性和有效性。方法回顾性分析上海长海医院泌尿外科2013年11月—2014年2月收治的单侧RCC合并下腔静脉癌栓行靶向药物治疗的4例患者的临床资料。4例患者均伴有不同程度的下腔静脉癌栓,按照美国梅奥医学中心的癌栓分类标准,患者癌栓分级均为Ⅱ级。因考虑癌栓体积大、腔静脉壁有受侵可能,初始均未采取手术治疗。4例患者均服用酪氨酸激酶抑制剂治疗,并每3个月复查胸部和双肾CT,其中2例患者于靶向治疗后3个月行肾癌根治手术。结果 4例患者肿瘤和癌栓在行靶向药物治疗3个月后均有不同程度缩小,2例行肾癌根治手术完整切除肿瘤和癌栓,2例未行手术(其中1例于用药后15个月癌栓级别由Ⅱ级降至Ⅰ级,左肾肿瘤体积亦明显缩小)。目前4例患者均持续行常规剂量靶向药物治疗。结论 RCC合并下腔静脉癌栓的患者采用靶向药物治疗可以使肿瘤体积缩小,癌栓不同程度缩小或降级,可能增加手术切除机会并降低手术难度。

Objective To evaluate the feasibility and effectiveness of targeted therapy for renal cell carcinoma with inferior vena cava cancer embolus. Methods Clinical data of 4 patients with unilateral renal cancer combined with inferior vena cava cancer embolus treated in Shanghai Changhai Hospital between November 2013 and February 2014 were retrospectively analyzed. Cancer embolus was classified as level Ⅱ according to Mayo Medical Center Standard. Surgical treatment was not performed firstly because the cancer embolus was so large and the wall of vena cava may be invaded. Tyrosine kinase inhibitor was taken in the 4 patients and chest and kidney CT were reexamined every 3 months. Two patients underwent radical nephrectomy 3 months after the targeted therapy. Results Tumors and cancer emboluses became smaller in all the 4 patients 3 months after the targeted therapy. Radical nephrectomy was successfully performed in two patients. The level of embolus was decreased from level Ⅱ to level Ⅰ in one patient who did not undergo radical nephrectomy. The targeted drugs were continually taken at standard dose in the 4 patients. Conclusion Targeted drugs can decrease the size of tumors and embolus and degrade embolus level before surgery, which may increase the possibility of surgical resection and reduce the operating difficulty.