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轉移腫瘤切除術對轉移性腎細胞癌生存率之影響：系統性文獻回顧與分析
謝博彥1,2、洪晟鈞3、李健儀3、陳卷書3、楊晨洸3、王賢祥3、盧嘉文3、程千里3、裘坤元3
1台中榮民總醫院 教學部；2臺北醫學大學 醫學系；3台中榮民總醫院 泌尿科 外科部
The effect of Metastasectomy on overall survival in metastatic renal cell carcinoma: systemic review and meta-analysis
PO-YEN HSIEH12, SHENG-CHUN HUNG3, JIAN-RI LEE3, CHUAN-SHU CHEN3, CHEN-KUANG YANG3, SHIAN-SHIANG WANG3, KEVIN LU3, CHENG-LI CHENG3, KUN-YUAN CHIU3
1Department of Education, Taichung Veterans General Hospital, Taichung, Taiwan;
2School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan;
3Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
Purpose: Metastasectomy (MTS) is a treatment option for patients with metastatic renal cell carcinoma (mRCC). Nevertheless, the advantages of MTS over survival remain controversial. This systemic review aims to compare survival outcomes of patients who underwent MTS and find out which clinical factors related to the results.
Materials and Methods: From inception to Jan 24, 2020, a systematic review of the Medline, EMBASE, PubMed, and Cochrane databases was performed. Studies that reported outcomes of patients who underwent MTS for the treatment of mRCC were included. The sites, time, and the number of metastasis were analyzed meanwhile. The primary efficacy end points were overall survival. A meta-analysis was performed to calculate hazard ratio, 95% confidence intervals, and I2 values. Forest plots were constructed for each analysis group.
Results: The systematic review and reference list search identified 294 articles, with 15 meeting study inclusion criteria. The MTX group showed competitive advantage in overall survival (Hazard ratio [MTS vs non MTS] = 2.52, 95% confidence interval 2.08-3.06, p < 0.001). Otherwise, the meta-analysis revealed changes in the overall survival outcomes which favors lung only metastasis (HR=1.87, 95% CI:1.55-2.26, p<0.001), asynchronous metastasis (HR=1.26, 95% CI:1.02-1.56, p=0.03), and fewer metastasis sites (HR=2.09, 95% CI:1.39-3.15, p<0.001).
Conclusion: Metastasectomy still remains treatment option for mRCC patients under fair performance status with prolonged overall survival time. The former operation has the additional advantages especially in patients with lung only metastasis, asynchronous metastasis, and fewer metastasis sites.