Metastatic renal cell carcinoma (RCC) is among the most lethal urological malignancies. However, small, localized RCCs (≤7 cm, stage T1) have an excellent prognosis. There is a rare patient subgroup diagnosed with synchronous distant metastasis (T1N0M1), of which very little is known in terms of survival outcomes and underlying disease biology. Herein, we examined the long-term survival of 27 patients with clear cell RCC (ccRCC) stage T1N0M1 in comparison to 18 patients without metastases (T1N0M0). Tumor tissue was stained by immunohistochemistry for CD8+ tumor infiltrating lymphocytes (TILs). As expected, patients with stage T1N0M1 showed a significantly worse median cancer specific survival (CSS; 2.8 years) than patients with stage T1N0M0 (17.7 years; HR 0.077; 95% CI, 0.022–0.262). However, eight patients (29.6%) with ccRCC stage T1N0M1 survived over five years, and three of those patients (11.1%) survived over a decade. Some of these patients benefitted from an intensified, multimodal treatment including metastasis-directed therapy. The number of CD8+ TILs was substantially higher in stage T1N0M1 ccRCCs than in stage T1N0M0 ccRCCs, suggesting a more aggressive tumor biology. In conclusion, long-term survival is possible in patients with ccRCC stage T1N0M1, with some patients benefitting from an intensified, multimodal treatment approach.
转移性肾细胞癌是最致命的泌尿系统恶性肿瘤之一。然而，小型局限性肾细胞癌（≤7厘米，T1期）预后良好。临床上存在一类罕见的患者亚群，被诊断为同时性远处转移（T1N0M1），关于其生存结局及潜在疾病生物学特征的研究甚少。本研究通过对比18例无转移患者（T1N0M0），对27例T1N0M1期透明细胞肾细胞癌患者的长期生存状况进行了分析。采用免疫组化染色检测肿瘤组织中CD8+肿瘤浸润淋巴细胞水平。结果显示，T1N0M1期患者中位癌症特异性生存期（2.8年）显著差于T1N0M0期患者（17.7年；风险比0.077；95%置信区间0.022-0.262），这与预期相符。但值得注意的是，8例（29.6%）T1N0M1期透明细胞肾细胞癌患者生存期超过5年，其中3例（11.1%）生存期超过10年。部分患者受益于包括转移灶定向治疗在内的强化多模式治疗方案。免疫组化分析显示，T1N0M1期透明细胞肾细胞癌中CD8+肿瘤浸润淋巴细胞数量显著高于T1N0M0期，提示其肿瘤生物学行为更具侵袭性。综上所述，T1N0M1期透明细胞肾细胞癌患者存在获得长期生存的可能性，部分患者可通过强化多模式治疗方案获益。
Long-Term Survival of Patients with Stage T1N0M1 Renal Cell Carcinoma
肿瘤(癌症)患者之家