Sarcomatoid renal cell carcinoma: Biologic behavior, prognosis, and response to combined surgical resection and immunotherapy
Sarcomatoid renal cell carcinoma: Biologic behavior, prognosis, and response to combined surgical resection and immunotherapy
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DOI：
10.1200/jco.1999.17.2.523
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发表时间：
1999-02-01
影响因子：
45.3
通讯作者：
Belldegrun, A
中科院分区：
文献类型：
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作者：
Cangiano, T;Liao, J;Belldegrun, A
目的：肾细胞癌（RCC）的肉瘤样变异是侵袭性肿瘤，对免疫治疗反应较差。我们报告了31例肉瘤样RCC联合手术切除和免疫治疗的结果。患者和方法：从加州大学洛杉矶分校肾癌项目的数据库中确定患者。我们回顾性回顾了1990年至1997年间诊断为肉瘤样RCC的31例连续患者。从病历中提取临床分期、转移部位、病理分期和免疫治疗类型。分析的主要终点是总生存期，并进行多变量分析以区分任何赋予改善生存期的因素。结果：患者中男性占26%，女性占74%，中位年龄59岁（34 ~ 73岁）。随访时间2 ~ 77个月（平均21.4个月）。28例患者（84%）在行根治性肾切除术时已知转移灶（67%为肺转移灶，40%为骨转移灶，21%为肝转移灶，33%为淋巴转移灶，15%为脑转移灶）。25例患者（81%）接受了免疫治疗，包括低剂量基于白细胞介素(IL)-2的治疗（5例）、肿瘤浸润性淋巴细胞加IL-2的治疗（9例）、高剂量基于IL-2的治疗（9例）、基于树突状细胞疫苗的治疗（1例）和单独基于干扰素的治疗（1例）。2例患者（6%）达到完全缓解（中位持续时间为46+个月），5例患者（15%）达到部分缓解（中位持续时间为36个月）。1年和2年的总生存率分别为48%和37%。通过多变量分析，年龄、性别和肉瘤样肿瘤的百分比（小于或小于50%）与生存率无显著相关性。与单纯手术治疗或任何其他形式的免疫治疗相比，接受高剂量IL-2治疗的患者生存率提高（P = 0.025）。调整年龄、性别和肉瘤样肿瘤百分比后，未接受高剂量IL-2治疗的患者的相对死亡风险高出10.4倍。最终病理T分期与预后无显著相关性，但淋巴结阳性患者的年随访死亡率高于其他人群（Cox回归分析1.26 vs 0.76）。结论：手术切除和高剂量基于il -2的免疫治疗可能对部分患者的肉瘤样rcc有一定的治疗作用。(C) 1999年由美国临床肿瘤学会出版。
Purpose: Sarcomatoid variants of renal cell carcinoma (RCC) are aggressive tumors that respond poorly to immunotherapy. We report the outcomes of 31 patients with sarcomatoid RCC treated with a combination of surgical resection and immunotherapy.Patients and Methods: Patients were identified from the database of the University of California Los Angeles Kidney Cancer Program. We retrospectively reviewed the cases of 31 consecutive patients in whom sarcomatoid RCC was diagnosed between 1990 and 1997. Clinical stage, sites of metastasis, pathologic stage, and type of immunotherapy were abstracted from the medical records. The primary end point analyzed was overall survival, and a multivariate analysis was performed to distinguish any factors conferring an improved survivorship.Results: Twenty-six percent of patients were male and 74% were female, and the median age was 59 years (range, 34 to 73 years). Length of follow-up ranged from 2 to 77 months (mean, 21.4 months). Twenty-eight patients (84%) had known metastases at the time of radical nephrectomy (67% had lung metastases and 40% had bone, 21% had liver, 33% had lymphatic, and 15% had brain metastases). Twenty-five patients (81%) received immunotherapy, including low-dose interleukin(IL)-2-based therapy (five patients), tumor-infiltrating lymphocyte-based therapy plus IL-2 (nine patients), high-dose IL-2-based therapy (nine patients), dendritic cell vaccine-based therapy (one patient), and interferon alpha-based therapy alone (one patient). Two patients (6%) achieved complete responses (median duration, 46+ months) and five patients (15%) achieved partial responses (median duration, 36 months). One- and 2-year overall survival rates were 48% and 37%, respectively. Using a multivariate analysis, age, sex, and percentage of sarcomatoid tumor (< or > 50%) did not significantly correlate with survival. Improved survival was found in patients receiving high-dose IL-2 therapy compared with patients treated with surgery alone or any other form of immunotherapy (P =.025). Adjusting for age, sex, and percentage of sarcomatoid tumor, the relative risk of death was 10.4 times higher in patients not receiving high-dose IL-2 therapy. Final pathologic T stage did not correlate significantly with outcome, but node-positive patients had a higher death rate per year of follow-up than did the rest of the population (1.26 v 0.76, Cox regression analysis).Conclusion: Surgical resection and high-dose IL-2-based immunotherapy may play a role in the treatment of sarcomatoid RCCs in select patients. (C) 1999 by American Society of Clinical Oncology.