Does Radical Nephrectomy with Immunochemotherapy Have Any Superiority over Embolization Alone in Metastatic Renal Cell Carcinoma?
Does Radical Nephrectomy with Immunochemotherapy Have Any Superiority over Embolization Alone in Metastatic Renal Cell Carcinoma?
复制标题
在转移性肾细胞癌中，根治性肾切除术联合免疫化疗是否比单独栓塞治疗有优势？
作者：
D. Demirci;A. Tatlışen;O. Ekmekçioğlu;N. Özcan;R. Kaya
简介：我们评估了根治性肾切除术后免疫化疗和栓塞对转移性肾细胞癌患者生存的影响。患者和方法：该研究包括20例经组织学证实的肾细胞癌患者。综合治疗组10例，栓塞治疗组10例，因患者体能状态差或肿瘤无法切除而无法行肾切除术。对表现良好的患者（WHO标准0-1）进行根治性肾切除术。术后1个月内开始免疫化疗（干扰素α 2a和5-氟尿嘧啶）。干扰素α 2a皮下注射9 × 106 U/d，每周3次。在治疗的前5天，在4小时内静脉注射750 mg/m2 5-氟尿嘧啶。5-在最初的12天后，氟尿嘧啶治疗改为每周一次。联合治疗3个月。使用乙醇进行经动脉栓塞。栓塞肿瘤的主要肾动脉和寄生动脉。结果：两组患者的年龄分布、性别、患侧、肿瘤大小、T分期等差异无统计学意义。完成联合治疗后，6例患者在首次控制时显示进展。在联合治疗后的10个月内，只有1例患者（10%）病情稳定。栓塞组1例患者于第4天死于心肌梗死。6例患者在前3个月内检测到疾病进展，另外3例患者（30%）分别在14、17和55个月内病情稳定。在分析研究数据时，任何组均无完全缓解，无患者存活（死于肾细胞癌）。联合组的中位生存时间为11个月（1-80）（平均值±标准差：22.2 ± 9.1），栓塞组的中位生存时间为1个月（1-74）（平均值±标准差：17.5 ± 8.6）。两组患者的生存时间差异无统计学意义（p > 0.05）。结论：在这份初步报告中，栓塞组患者的临床表现明显差于肾切除加免疫化疗组患者。尽管有这些差异，联合治疗使用根治性肾切除术和免疫化疗不能显示优于栓塞单独，特别是在生存时间。
Introduction: We evaluated the results and effects of radical nephrectomy followed by immunochemotherapy and embolization alone on the survival of patients with metastatic renal cell carcinoma. Patients and Methods: The study included 20 patients with histologically confirmed renal cell carcinoma. Ten patients were in the combined therapy group and the other 10 patients who were unable to undergo nephrectomy because of poor performance status or unresectable tumor were in the embolization group. Radical nephrectomy was performed on patients with good performance status (WHO criteria 0–1). Immunochemotherapy (interferon alpha 2a and 5-fluorouracil) was started within 1 month after surgery. A dose of 9 × 106 U/day interferon alpha 2a was subcutaneously administered 3 times a week. A dose of 750 mg/m2 5-fluorouracil was administered intravenously during 4 h in the first 5 days of treatment. 5-Fluorouracil therapy was converted to weekly intervals after the first 12 days. Combined therapy was continued for 3 months. Ethanol was used for transarterial embolization. The main renal arteries and parasitic arteries of the tumor were embolized. Results: There were no significant differences in age distribution, sex, affected side, tumor size and T stage between the groups. After completion of the combined therapy, 6 patients showed progression at the first control. Only 1 patient (10 %) had stable disease throughout the 10 months after combined therapy. One patient died of myocardial infarction on the 4th day in the embolization group. While progressive disease within the first 3 months was detected in 6 patients, the other 3 patients (30%) had stable disease for 14, 17 and 55 months, respectively. There was no complete response in any group and no patient was alive (died of renal cell carcinoma) at the time of the analysis of the study data. Whereas the median survival time was 11 months (1–80) (mean ± SE: 22.2 ± 9.1) in the combined group, this time was a median of 1 month (1–74) (mean ± SE: 17.5 ± 8.6) in the embolization group. There was no statistically significant difference in survival time between the groups (p > 0.05). Conclusion: In this preliminary report, the clinical findings in embolization-group patients were definitively worse than the nephrectomy plus immunochemotherapy-group patients. In spite of these differences, combination therapy using radical nephrectomy and immunochemotherapy could not show superiority to embolization alone, especially in terms of survival time.
影响因子：
158.5
作者：
Flanigan, RC;Salmon, SE;Crawford, ED
通讯作者：
Crawford, ED