Cytoreductive nephrectomy for kidney cancer with sarcomatoid histology--is up-front resection indicated and, if not, is it avoidable?
Cytoreductive nephrectomy for kidney cancer with sarcomatoid histology--is up-front resection indicated and, if not, is it avoidable?
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DOI：
10.1016/j.juro.2009.07.049
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发表时间：
2009-11
期刊：
影响因子：
--
通讯作者：
Belldegrun AS
中科院分区：
文献类型：
--
作者：
Shuch B;Said J;La Rochelle JC;Zhou Y;Li G;Klatte T;Kabbinaavar FF;Pantuck AJ;Belldegrun AS
细胞减灭性肾切除术在某些患者中具有生存优势。已知具有肉瘤样特征的患者预后较差。我们回顾了手术在这一人群中的作用，以了解这些患者是否可以在术前识别。回顾性分析了被鉴定为肉瘤样特征或梭形细胞的肾细胞减灭术病例。记录组织学、分级、肉瘤样成分的存在和百分比。临床病理特征，生存和全身治疗进行了比较，没有肉瘤样组织学的情况下。在417例接受细胞减灭性肾切除术的患者中，共发现62例肉瘤样组织学肿瘤，占14.9%。肉瘤样转化的百分比变化很大，范围为2%至100%，平均值/中位数为49.8%/50%。肉瘤样特征的百分比增加与预后不良相关。有肉瘤样特征和无肉瘤样特征的患者具有相似的临床特征。在肉瘤样组中，T分期较高（p <0.001），非透明细胞组织学发生率增加（p <0.001）。肉瘤样组织学特征患者的中位生存期为4.9个月，而非肉瘤样组织学特征患者的中位生存期为17.7个月（p <0.001）。肉瘤样组织学患者术后治疗的效果明显较差。尽管进行了积极的手术和术后治疗，接受细胞减灭性肾切除术的肉瘤样组织学患者的预后仍很糟糕。肉瘤样成分的可变性和缺乏特异性临床特征使得术前鉴别具有挑战性。研究应该集中在确定这类肿瘤的生物标志物上，这些生物标志物可能允许预先进行系统治疗，并为有反应的患者保留手术。
Cytoreductive nephrectomy has a survival advantage in select patients. Patients with sarcomatoid features are known to have poor outcomes. We reviewed the role of surgery in this population to see if these patients could be identified preoperatively. Cytoreductive nephrectomy cases identified as having sarcomatoid features or spindle cells were reviewed. The histology, grade, and the presence and percentage of sarcomatoid elements were recorded. Clinicopathological characteristics, survival and systemic therapy were compared to cases without sarcomatoid histology. A total of 62 tumors with sarcomatoid histology were identified, accounting for 14.9% of the 417 patients undergoing cytoreductive nephrectomy. The percentage of sarcomatoid transformation widely varied with a range of 2% to 100% and a mean/median of 49.8%/50%. An increased percentage of sarcomatoid features is associated with a worse prognosis. Patients with and those without sarcomatoid features had similar clinical characteristics. In the sarcomatoid group a higher T stage (p <0.001) and increased incidence of nonclear cell histology (p <0.001) were noted. Median survival of patients with sarcomatoid features was 4.9 vs 17.7 months for nonsarcomatoid histology (p <0.001). Use of postoperative therapy was significantly worse for patients with sarcomatoid histology. Patients with sarcomatoid histology undergoing cytoreductive nephrectomy have a dire prognosis despite aggressive surgery and postoperative therapy. The variability in the sarcomatoid component and the lack of specific clinical features make preoperative identification challenging. Research should focus on identifying biomarkers for this subset of tumors that may allow up-front systemic therapy with surgery reserved for responding patients.
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影响因子：
45.3
作者：
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通讯作者：
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