First Experience of Active Surveillance Before Systemic Target Therapy in Patients With Metastatic Renal Cell Carcinoma
First Experience of Active Surveillance Before Systemic Target Therapy in Patients With Metastatic Renal Cell Carcinoma
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DOI：
10.1016/j.urology.2013.03.035
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发表时间：
2013-07-01
期刊：
影响因子：
2.1
通讯作者：
Sakai, Yasuyuki
中科院分区：
文献类型：
--
作者：
Matsubara, Nobuaki;Mukai, Hirofumi;Sakai, Yasuyuki
目的揭示惰性转移性肾细胞癌（mRCC）患者亚群的初始主动监测（AS）和随后延迟全身靶向治疗的结果。方法我们回顾性分析了mRCC患者的临床和病理数据，这些患者最初在全身治疗前接受计划的AS监测，因为他们的偏好和无症状或缓慢进展的疾病，2000年到2011年在我们机构工作主要结果指标是无进展生存期（PFS）和总生存期（OS）。结果29例AS开始时有转移性病灶的患者符合本分析的条件。AS开始时的中位年龄为69岁。在这些患者中，65%复发，35%处于IV期。所有患者均接受过肾切除术，86%患有透明细胞癌。根据纪念斯隆-凯特琳癌症中心（MSKCC）和Heng标准，没有患者被归类为低风险。中位随访期为35.4个月。在72%的患者中观察到疾病进展，但只有14%在随访期间死亡。中位PFS时间为26.1个月。在观察到疾病进展后，只有58%的患者接受了治疗。中位OS尚未达到，但12、24和48个月OS率分别为96.4%、88.7%和83.8%。结论接受AS的患者的PFS和OS是可以接受的。AS可能是一种合理的方法，特别是对于病程长、惰性的患者。可能需要更大样本量的进一步观察性研究。泌尿学82：118 - 123，2013年。(C)2013 Elsevier Inc.
OBJECTIVE To reveal the outcomes of initial active surveillance (AS), followed by deferred systemic target therapy, in a subpopulation of patients with indolent metastatic renal cell carcinoma (mRCC).METHODS We retrospectively reviewed the clinical and pathologic data of patients with mRCC, who initially were monitored by planned AS before systemic therapy because of their preference and asymptomatic or slowly progressive disease, at our institution between 2000 and 2011. The primary outcome measures were progression-free survival (PFS) and overall survival (OS).RESULTS Twenty-nine patients with a metastatic lesion at start of AS were eligible for this analysis. The median age at the start of AS was 69 years. Of these patients, 65% had recurrent disease and 35% were in stage IV. All patients had undergone nephrectomy and 86% had clear-cell carcinoma. No patients were categorized into a poor risk according to Memorial Sloan-Kettering Cancer Center (MSKCC) and Heng criteria. The median follow-up period was 35.4 months. Disease progression was observed in 72% of patients, but only 14% died during the follow-up period. The median PFS time was 26.1 months. After disease progression was observed, only 58% of these patients received treatment. The median OS had not been reached, but 12, 24, and 48 months OS rates were 96.4%, 88.7%, and 83.8%, respectively.CONCLUSION PFS and OS of patients who underwent AS were acceptable. AS might be a reasonable approach, particularly for patients with prolonged, indolent course of the disease. Further observational studies with a larger sample size might be needed. UROLOGY 82: 118-123, 2013. (C) 2013 Elsevier Inc.