减瘤手术联合靶向治疗在转移性肾癌合并下腔静脉癌栓治疗中的临床价值

Clinical value of cytoreductive nephrectomy for metastatic renal cell carcinoma patients with inferior vena cava tumor thrombus

目的:探讨减瘤手术联合靶向治疗转移性肾癌(metastatic renal cell carcinoma,mRCC)合并下腔静脉癌栓患者的安全性和有效性。方法:回顾性分析2011年11月至2019年02月收治的13例mRCC合并下腔静脉癌栓患者的临床资料,根据有无靶向治疗分为靶向组和非靶向组。靶向组8例,男7例,女1例,平均年龄(48.38±13.92)岁,肿瘤位于左侧5例,右侧3例,平均直径(9.93±5.37)cm。非靶向组5例,男4例,女1例,平均年龄(60.60±5.37)岁,肿瘤位于左侧1例,右侧4例,平均直径(11.24±2.76)cm。结果:术后病理:靶向组透明细胞癌6例,乳头状肾细胞癌和肉瘤样癌各1例,术后TNM分期T_(3b)N_(1)M_(0)和T_(4)N_(1)M_(1)各1例,T_(3a)N_(1)M_(1)3例,T_(3b)N_(1)M_(1)3例。非靶向组透明细胞癌2例,Xp11.2易位/TFE3基因融合相关性肾癌、乳头状肾细胞癌和低分化癌各1例,术后TNM分期T_(3b)N_(1)M_(1)和T_(3c)N_(1)M_(1)各1例,T_(4)N_(1)M_(1)3例。所有患者获随访4~47个月,中位随访时间27个月。靶向组和非靶向组中位无进展生存期分别为6.5个月和2个月,半年、1年无进展生存率分别为50.00%(4/8)、37.50%(3/8)和40.00%(2/5)、20.00%(1/5),两组对比无统计学差异(HR=0.46,95%CI:0.13~1.70,P=0.1259)。靶向组和非靶向组中位总生存期分别为41个月和8个月,1年和2年总存活率分别为100.00%(8/8)、87.50%(7/8)和20.00%(1/5)、20.00%(1/5),两组对比统计学差异显著(HR=0.17,95%CI:0.03~0.99,P=0.0005)。结论:减瘤手术治疗mRCC并下腔静脉癌栓患者安全有效,术后进行靶向治疗可显著延长患者总生存期。

Objective:To investigate the efficacy and safety of cytoreductive nephrectomy combined with targeted therapy for metastatic renal cell carcinoma(mRCC)with inferior vena cava(IVC)tumor thrombus.Methods:The clinical data of 13 mRCC patients with IVC tumor thrombus from November 2011 to February 2019 in our hospital were analyzed retrospectively.In the target group,there were 8 cases,7 males and 1 female,with an average age of(48.38±13.92)years old.Five tumors were on the left side and three tumors were on the right side,with an average diameter of(9.93±5.37)cm.In the non-targeted group,there were 5 cases,4 males and 1 female,with an average age of(60.60±5.37)years old.The tumor was located in 1 case on the left and 4 cases on the right,with an average diameter of(11.24±2.76)cm.Results:Postoperative pathology:In the targeted group,there were 6 cases of clear cell carcinoma,1 case of papillary renal cell carcinoma and 1 case of sarcomatoid carcinoma,1 case of T_(3b)N_(1)M_(0) and T_(4)N_(1)M_(1) respectively,3 cases of T_(3a)N_(1)M_(1) and T_(3b) N_(1)M_(1 )respectively.In the non-targeted group,there were 2 cases of clear cell carcinoma,1 case of Xp11.2 translocation/TFE3 gene fusion related renal carcinoma,papillary renal cell carcinoma and poorly differentiated carcinoma respectively,1 case of T_(3b)N_(1)M_(1) and T_(3c) N_(1)M_(1) respectively,and 3 cases of T_(4)N_(1)M_(1).All patients were followed up for 4~47 months,with a median follow-up of 27 months.The median progression free survival(PFS)time was 6.5 months and 2 months in the target group and non-target group,and the half-year and one-year PFS rates were 50.00%(4/8),37.50%(3/8)and 40.00%(2/5),20.00%(1/5),respectively.There was no significant difference between the two groups(HR=0.46,95%CI:0.13~1.70,P=0.1259).The median overall survival(OS)time of the target group and the non-target group was 41 months and 8 months respectively,and the 1-year and 2-year OS rates were 100.00%(8/8),87.50%(7/8)and 20.00%(1/5),20.00%(1/5),respectively.The difference was statistically significant(HR=0.17,95%CI:0.03~0.99,P=0.0005).Conclusion:Cytoreductive nephrectomy is safe and effective for mRCC patients with IVC tumor thrombus.Targeted therapy can significantly prolong the overall survival of patients.