轉移性腎細胞惡性腫瘤在減積手術後對於標靶治療之預後因子探討
曲元正、張英勛、邵翊紘、甘弘成、劉忠一、虞凱傑、莊正鏗、吳俊德、馮思中
林口長庚紀念醫院外科部 泌尿科系
Prognostic factors for patients with de novo metastatic renal cell carcinoma receiving cytoreductive nephrectomy followed with target therapy: Who will really benefit from the cytoreductive nephrectomy?
Yuan-Cheng Chu1, Ying-Hsu Chang1, I-Hung Shao1, Hung-Cheng Kan1, Chung-Yi Liu1, Kai-Jie, Yu1, Cheng-Keng Chuang1, Chun-Te Wu2, See-Tong Pang1
1Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Linkou medical center, Taoyuan, Taiwan; 2Division of Urology, Department of Surgery; KeeLung Chang Gung Memorial Hospital
Purpose:
The role of cytoreductive nephrectomy (CN) is facing challenges in the era of target therapy, but it remains a treatment option for metastatic renal cell carcinoma (mRCC). This study aimed to find out the prognostic factors in patients with de novo mRCC who underwent cytoreductive nephrectomy followed by target therapy.
Materials and Methods:
A retrospective study including patients who received cytoreductive nephrectomy followed by target therapy from December 2010 to November 2017 was performed. Preoperative general characteristics and tumor-related parameters were collected.
Overall survival was recorded as the endpoint. All parameters were analyzed using univariate and multivariate methods for the prognosis of overall survival.
Results:
A total of 60 patients were included in this study, with a dominant clear cell histology accounting for 75% of all tumors. Lung metastasis showed the highest incidence of distant site metastasis, presenting in 60% of the patients. The mean duration of the 1st target agent was 369.2 days, and the mean overall survival time was 706.1 days. Performance status, bone metastasis, liver metastasis, duration of the 1st target agent, lymphocyte count, platelet count, serum albumin level, neutrophil–lymphocyte ratio, and platelet–lymphocyte ratio were statistically significant prognostic factors in the multivariate analysis. More adverse prognostic factors were observed, and more severe outcomes were noted.
Conclusion:
Based on this study and previous other studies, cytoreductive nephrectomy remains a part of treatment in carefully selected patients with de novo mRCC. In patients with more adverse prognostic factors, initial CN should be deliberated and discussed in the multidisciplinary teams.