轉移性腎細胞癌之腫瘤細胞減滅手術---林口長庚醫院標靶治療之經驗
李承哲、張英勛、馮思中、莊正鏗、劉忠一、邵翊紘、甘弘成、虞凱傑
林口長庚紀念醫院外科部泌尿外科
Survival benefit after cytoreductive nephrectomy in metastatic renal cell carcinoma: CGMH-LK experience in targeted therapy era
Chen-Che Lee, Ying-Hsu Chang,See-Tong Pang,Cheng-Keng Chuang, Chung-Yi Liu, I-Hung Shao, Hung-Cheng Kan, Kai-Jie Yu,
Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Linkou
Purpose: Renal cell carcinoma is the most common malignancy of kidney and renal pelvis, with up to 30% of patients being metastatic during first visit. In the target therapy era, many retrospective studies showed partial response and complete regression in mRCC treated with adjuvant therapy following cytoreductive nephrectomy (CyNx). Although prospective trial CARMENA is still undergoing, we would like to present the experience from our single institute.
Materials and Methods: From 2002 to 2014, a total of 2086 RCC patients were treated. Patients with missing data, uncertain pathology reports and those who were transferred to other hospital for further treatment were excluded. A total of 870 patients were enrolled with metastatic RCC. Patient's basic characteristics, laboratory data, image studies, clinicopathologic parameters and last follow-up or death date were collected. Types of targeted therapy or immunotherapy were also analyzed in subgroups. Primary endpoints were overall survival and progression-free survival.
Results: Of 870 mRCC patients, 42 of them received cytoreductive surgery. Survival was compared to those who received merely target therapy and/or immunotherapy without surgery.
From current data, patients receiving CyNx were significantly younger (62 vs. 73 years old, p<0.005). The non-cytoreductive group has more LN identified in CT (cN1 56.6% vs. 47.6%, p<0.005). There is a trend of survival benefit toward cytoreductive group with one year overall survival rate of 87% versus 77% and two-year overall survival rate of 75% vs. 69%. Long-term overall survival for five years also showed advantage for cytoreductive nephrectomy with 66% versus 47 % (p=0.168).
Conclusion: Cytoreductive nephrectomy prolonged survival outcome in mRCC. Based on currently available retrospective studies on the role of CyNx in targeted therapy era, we further contribute our experience for the benefit of cytoreduction.