文章：

在酪氨酸激酶抑制剂与免疫检查点抑制剂时代，晚期肾细胞癌患者转移病灶完全手术切除的影响

Impact of Complete Surgical Resection of Metastatic Lesions in Patients with Advanced Renal Cell Carcinoma in the Era of Tyrosine Kinase Inhibitors and Immune Checkpoint Inhibitors

原文发布日期：19 February 2024

DOI: 10.3390/cancers16040841

类型: Article

开放获取: 是

英文摘要：

Complete metastasectomy (CM) in metastatic renal cell carcinoma (mRCC) has demonstrated efficacy in the cytokine era, but its effectiveness in the era of tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs) remains unclear. A multi-institutional database included clinicopathological data of 367 patients with mRCC. Patients were divided into two groups: the CM group and the non-CM group. These two groups were compared before and after propensity score matching (PSM). Cox proportional hazard models were used to detect factors associated with disease-free survival (DFS) and overall survival (OS) from mRCC diagnosis. The CM group showed a significant association with longer overall survival compared to the non-CM group in the PSM-unadjusted cohorts (p< 0.001, hazard ratio 0.49, 95% confidence interval 0.35–0.69), but no superiority was noted in the adjusted cohorts. The median DFS after CM was 24 months, with no significant differences based on relapse timing. Notably, the international metastatic RCC database consortium risk categories and metastatic burden were associated with DFS. This study supports the potential of CM in mRCC management during the TKI/ICI era, although limitations including sample size and selection bias need to be considered.

摘要翻译： 

在细胞因子时代，完全性转移灶切除术（CM）治疗转移性肾细胞癌（mRCC）已显示出疗效，但其在酪氨酸激酶抑制剂（TKI）和免疫检查点抑制剂（ICI）时代的有效性尚不明确。一项多机构数据库纳入了367例mRCC患者的临床病理资料。患者被分为两组：CM组和非CM组。在倾向评分匹配（PSM）前后对两组进行比较。采用Cox比例风险模型分析与mRCC诊断后无病生存期（DFS）和总生存期（OS）相关的因素。在未校正PSM的队列中，CM组与更长的总生存期显著相关（p<0.001，风险比0.49，95%置信区间0.35–0.69），但在校正后的队列中未观察到优势。CM后的中位DFS为24个月，且复发时间无显著差异。值得注意的是，国际转移性肾细胞癌数据库联盟风险分类和转移负荷与DFS相关。本研究支持CM在TKI/ICI时代mRCC治疗中的潜力，但需考虑样本量和选择偏倚等局限性。

原文链接：

Impact of Complete Surgical Resection of Metastatic Lesions in Patients with Advanced Renal Cell Carcinoma in the Era of Tyrosine Kinase Inhibitors and Immune Checkpoint Inhibitors