摘要
目的 探讨术前靶向治疗对肾癌并下腔静脉癌栓的疗效及对手术策略的影响.方法 回顾性分析2012年12月至2017年5月我院术前靶向治疗后行根治性肾切除术+下腔静脉癌栓取出术的18例患者的临床资料.男16例,女2例.年龄33 ~75岁,中位年龄53.5岁.体重指数18.1 ~30.4 kg/m2,平均24.7 kg/m2.左侧肿瘤4例,右侧肿瘤14例.通过靶向治疗前后影像学资料(CT/MRI)的对比,评估原发肿瘤大小、下腔静脉癌栓高度和癌栓最大径的变化.癌栓分级参考Mayo Clinic分级系统.靶向药物治疗前,癌栓分级:Ⅰ级1例,Ⅱ级12例,Ⅲ级4例,Ⅳ级1例.结果 18例中6例接受索拉非尼治疗,9例接受舒尼替尼治疗,3例接受阿昔替尼治疗.治疗1 ~6个周期,中位值为2个周期.3例用药后出现严重不良反应(≥3级),1例因不良反应严重治疗1个周期后停药并接受手术治疗.靶向药物治疗后,11例(61.1%)癌栓高度明显降低,5例(27.8%)癌栓高度保持稳定,2例(11.1%)癌栓高度增加.癌栓高度平均变化-0.53 cm(-4.23~1.12 cm),癌栓最大径平均变化-0.30 cm(-1.23~0.29 cm).4例(22.2%)靶向治疗后癌栓成功降级,其中3例(均为Ⅲ级以上)改变了手术策略,术中避免了开胸、体外循环、第二肝门阻断及机器人辅助下左右翻肝等高难度操作,降低了手术难度.随访时间4 ~51个月(中位时间15个月),9例出现新发转移灶, 7例术后因肾癌伴广泛转移死亡.结论 虽然术前靶向治疗对下腔静脉癌栓的疗效有限,但对于Ⅲ级以上癌栓患者临床获益相对明显.术前靶向治疗未显著增加围手术期死亡率及严重并发症的发生风险.
Objective To investigate the therapeutic effects of presurgical TMT on the heights and levels of inferior vena cava(IVC)thrombi,and to assess its impact on surgical strategy.Methods We retrospectively reviewed data of 18 patients with renal cell carcinoma(RCC)involving IVC tumor thrombi who were treated at our hospital with presurgical TMT followed by an IVC thrombectomy.Data from 18 patients(16 men and 2 women)were included in the analysis.The median age was 53.5 years(range:33-75 years),and the mean BMI was 24.7kg/m2(rrange:18.1 -30.4 kg/m2).4 cases of tumors located in the left kidney,14 cases were right.The changes in heights and levels of the IVC thrombi were compared using computed tomography or magnetic resonance imaging.The IVC tumor thrombus level was evaluated according to the Mayo classification.Results The tumor thrombus levels before TMT were stage Ⅰ in 1 patient,Ⅱ in 1 2 patients,Ⅲ in 4 patients,and Ⅳ in 1 patient.The presurgical TMT was sorafenib in 6 patients(33.3%),sunitinib in 9(50.0%),and axitinib in 3(16.7%).After a median of 2 treatment cycles(range:1-6 cycles),three patients experienced grade 3 adverse events.One patient stopped treatment after 6 weeks owing to intolerable skin reactions and difficulty walking.The tumor thrombus height decreased measurably in 11 patients(61.1%).The thrombus height remained stable in 5 patients(27.8%)and was enlarged in 2(11.1%).The median reduction of tumor thrombus height was -0.53 cm (range:-4.23 to 1.21 cm).The median change in the maximum diameter of the thrombus was -0.30 cm (range:-1.23 to 0.29 cm).Down-staging of the thrombus level occurred in 4 patients(22.2%);the surgical strategy was modified in 3 patients(level≥Ⅲ)to avoid cardiopulmonary bypass and complicated liver mobilization under robot-assisted laparoscopy.Conclusions Our data suggest a limited influence of presurgical TMT,with a positive benefit in RCC patients with level Ⅲ and Ⅳ thrombus.Thrombus-level regression may potentially alter the surgical strategy,especially robotic
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2018年第S1期45-49,共5页
Chinese Journal of Urology
关键词
肾癌
下腔静脉癌栓
术前靶向治疗
索拉非尼
舒尼替尼
Renal cell carcinoma
Tumor thrombus
Targeted molecular therapy
Sorafenib
Sunitinib
