Patient survival after surgery for osseous metastases from renal cell carcinoma
Patient survival after surgery for osseous metastases from renal cell carcinoma
复制标题
DOI：
10.2106/jbjs.f.00603
复制
发表时间：
2007-08-01
影响因子：
5.3
通讯作者：
Yasko, Alan W.
中科院分区：
文献类型：
--
作者：
Lin, Patrick P.;Mirza, Attiqa N.;Yasko, Alan W.
背景：肾细胞癌骨转移是一种高度破坏性的血管病变。由于存在危及生命的出血风险和对其他治疗方法的抵抗力，它们构成了独特的外科挑战。这项回顾性研究的目的是评估可能影响肾癌转移性肿瘤手术治疗后生存率的因素。方法：我们对1974年至2004年间在一家机构接受转移性肾癌治疗的295例患者进行了回顾性研究。共有226名男性和69名女性。共有368例肾细胞肿瘤转移至四肢和骨盆的患者接受治疗。手术方式包括刮除骨水泥和/或内固定214个肿瘤，整块切除117个，闭合髓内钉27个，截肢4个，其他措施6个。采用Kaplan-Meier分析计算总生存率。结果：患者1、5年总生存率分别为47%和11%。转移方式对生存率有显著影响(p<；0.0001)：单发骨转移的患者总体生存率最好。多发性骨转移患者的生存率高于肺转移患者(p=0.009)。透明细胞组织学亚型也与较好的存活率相关(p<；0.0001)。肿瘤分级不能预测生存期(p=0.17)。术后4周内死亡15例(5%)。死亡原因包括急性肺功能衰竭(7例)、多器官功能衰竭(6例)、脑血管意外(1例)和高钙血症(1例)。没有死亡归因于术中出血。讨论：相当一部分转移性肾细胞癌患者的生存期超过12个月是可能的。组织学类型为透明细胞、仅有骨转移和单发转移的患者存活率较高。肺转移的存在并不能可靠地预测早期死亡，一些患有肺部和全身疾病的患者可能会存活数年。这些数据对外科医生在为这些患者选择治疗方案时非常重要。例如，疾病的局部控制和植入物的稳定性对于有可能长期存活的患者来说是重要的问题。证据级别：预后级别II。有关证据级别的完整描述，请参阅作者的说明。
Background: Skeletal metastases from renal cell carcinoma are highly destructive vascular lesions. They pose unique surgical challenges due to the risk of life-threatening hemorrhage and resistance to other treatments. The goal of this retrospective study was to evaluate factors that may affect survival after surgical treatment of metastases of renal cell carcinoma.Methods: We performed a retrospective review of a series of 295 consecutive patients who had been treated for metastatic renal cell carcinoma at one institution between 1974 and 2004. There were 226 men and sixty-nine women. A total of 368 metastases of renal cell tumors to the extremities and pelvis were treated. The surgical procedures included curettage with cementing and/or internal fixation (214 tumors), en bloc resection (117), closed nailing (twenty-seven), amputation (four), and other measures (six). Overall survival was calculated with Kaplan-Meier analysis. The log-rank test was used to evaluate the effect of different variables on overall survival.Results: The overall patient survival rates at one and five years were 47% and 11%, respectively. The metastatic pattern had a significant effect on the survival rate (p < 0.0001): patients with a solitary bone metastasis had the most favorable overall survival rate. Patients with multiple bone-only metastases had a better survival rate than patients with pulmonary metastases (p = 0.009). A clear-cell histological subtype was also associated with better survival (p < 0.0001). The tumor grade did not predict survival (p = 0.17). Fifteen patients (5%) died within four weeks after surgery. The causes included acute pulmonary failure (seven patients), multiorgan failure (six), cerebrovascular accident (one), and hypercalcemia (one). There were no deaths attributable to intraoperative hemorrhage.Discussion: Survival beyond twelve months is possible for a substantial proportion of patients with metastatic renal cell carcinoma. Patients with a clear-cell histological subtype, bone-only metastases, and a solitary metastasis have superior survival rates. The presence of pulmonary metastases does not predict early death in a reliable manner, and some patients may survive for years with pulmonary and systemic disease. The data are important for surgeons to consider when choosing treatment for these patients. For example, local control of disease and implant stability are important issues for patients with a potential for a long duration of survival.Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.