轉移性腎細胞癌使用標靶藥物的病人有無接受減積腎切除手術之存活率

戴盟哲¹、魏子鈞^1,2、張延驊^1,2、范玉華^1,2、林子平^1,2、黃逸俢^1,2、鍾孝仁^1,2、林登龍^1,2、

陳光國^1,2

台北榮民總醫院 泌尿部¹；國立陽明大學醫學院 泌尿學科 書田泌尿科學研究中心²

The survival outcome of targeted therapy with or without prior cytoreductive nephrectomy for patients with metastatic renal cell carcinoma

Meng-Che Tai¹, Tzu-Chun Wei^1,2, Yen-Hwa Chang^1,2, Yu-Hua Fan^1,2, Tzu-Ping Lin^1,2, Eric Yi-Hsiu Huang^1,2, Xiao-Jen Zhong^1,2, Alex T.L. Lin^1,2, Kuang-Kuo Chen^1,2

Department of Urology, Taipei Veterans General Hospital, Taiwan¹

Department of Urology, School of Medicine and Shu-Tien Urological Institute, National Yang-Ming University, Taipei, Taiwan²

Purpose:

For patients with metastatic renal cell carcinoma (mRCC), several targeted therapy have been approved as the standard treatment based on improvement in progression-free and overall survival. Previously in cytokine era, the evidences indicated cytoreductive nephrectomy (CN) to be beneficial. However, this is not strongly established for targeted therapy since there have not been supports from randomized controlled trials yet (SURTIME and CARMENA). Therefore, we aimed to evaluate the survival outcome between adjuvant targeted therapy following CN and targeted therapy alone.

Materials and Methods:

From October 2009 to January 2016, total 48 patients with initially diagnosed mRCC were treated with targeted therapy with or without prior CN at Taipei Veterans General Hospital. Demographic data, risk classification, histopathological reports, and clinical information were compared with student’s t-test and chi-square tests. The progression-free and overall survival were analyzed with Kaplan-Meier curves..

Results:

Of total 48 patients included, 30 patients received CN before targeted therapy and 18 patients were treated with targeted therapy alone. There were no differences in MSKCC and IMDC risk classification between these two groups, as well as other demographic data. However, patients in the CN group tend to have higher T stage, higher ISUP grade, and less lymph nodes metastasis (P=0.013, 0.004 and 0.027, respectively). The median progression-free and overall survival of CN group versus targeted therapy alone were 15.1 (95% CI, 9.7 to 20.4) versus 6.6 months (95% CI, 2.9 to 10.2; P=0.006) and 30.4 (95% CI, 21.4 to 39.5) versus 13.6 months (95% CI, 7.5 to 19.6; P=0.003), respectively.

Conclusions:

In our retrospective analysis, patients with initially diagnosed metastatic renal cell carcinoma who received cytoreductive nephrectomy before targeted therapy have significantly better progression-free and overall survival than those with targeted therapy alone, as long as it is feasible.