酪氨酸激酶抑制剂新辅助治疗高危肾癌的临床研究  

Clinical study of neoadjuvant therapy of tyrosine kinase inhibitor in high-risk renal cell carcinoma

作　　者：李永强[1] 李汉忠[1] 邓建华[1] 郑克文[1] 范欣荣[1] 文进[1] 

机构地区：[1]中国医学科学院北京协和医院泌尿外科,100730

出　　处：《中华泌尿外科杂志》2015年第3期175-178,共4页Chinese Journal of Urology

摘　　要：目的 探讨对高危肾癌患者采用酪氨酸激酶抑制剂（tyrosine kinase inhibitor,TKI）靶向药物术前新辅助治疗的临床价值和安全性. 方法 2010年6月至2013年12月对33例高危肾癌患者行TKI靶向药物治疗,其中8例TKI靶向药物治疗后接受手术治疗.男6例,女2例.年龄42 - 56岁,平均50岁.7例伴有副肿瘤综合征,1例为双肾癌.肿瘤分期：T3aN1M1期和T3bN0M0期各3例,T3aN0M0期和T3bN0M1期各1例,其中淋巴结和肺转移各3例,骨转移1例.4例合并下腔静脉瘤栓,其中3例MayoⅢ级,1例MayoⅣ级.术前美国东部肿瘤协作组评分：3分3例,2分4例,0分1例.8例均先口服TKI靶向药物,之后接受手术治疗.4例口服舒尼替尼,50 mg,1次/d,服药4周停2周;4例口服索拉非尼,400 mg,2次/d,持续用药.TKI靶向药物应用8-12周,术前停药6-16 d,平均12d. 结果 8例均耐受TKI靶向药物治疗.7例伴有副肿瘤综合征患者一般状况明显改善,其中3例行根治性肾切除术＋下腔静脉瘤栓取出术,2例行腹腔镜下根治性肾切除术,1例行深低温停循环根治性肾切除术＋下腔静脉瘤栓取出术,1例行根治性肾切除术.1例双侧肾癌患者双侧肿瘤明显缩小,行双侧保留肾单位手术.8例术中可见肿瘤与周围组织有轻、中度粘连.术中出血量120-500 ml,平均280 ml.围手术期无严重并发症发生,手术切口均愈合良好.病理诊断均为肾透明细胞癌.术后4例继续服用TKI药物.随访4-42个月,8例均存活,未见肿瘤复发;4例术前有转移患者疗效评价为疾病稳定. 结论 TKI靶向药物新辅助治疗高危肾癌患者是安全的,不增加手术风险.对于不耐受手术患者,该方法可改善患者一般状况,提高手术耐受性,创造手术机会;对于孤立肾肾癌、双肾癌患者,增加了行保留肾单位手术的可能性.Objective To investigate the safety and clinical significance in presurgical application of tyrosine kinase inhibitor （TKI） targeted therapy in high-risk renal-cell-carcinoma patients.Methods TKI targeted therapy was applied to 33 high-risk renal-cell-carcinoma patients from Jun.2010 to Dec.2013,7 cases with paraneoplastic symdromes and 1 with bilateral lesions received surgical treatments.There were 6 males and 2 females in this group with average age of 50 （42-56） years.They were high-risk patients because of renal tumor and vena caval tumor thrombus in 3 cases,renal tumor and vena caval tumor thrombus and hypercalcinemia in 1 case,renal tumors with metastasis to lung and lymph nodes in 2 cases,renal tumor with metastasis to lung and bones in 1 cases,and bilateral kidney cancer in 1 case.The clinical stages included 3 cases of T3aN1M1 and T3bN0M0 respectively,and 1 case of T3bN0M1 and T3aN0M0,respectively.The primary metastasis sites were lymph nodes and lung （3 cases respectively）,and another 1 in bone.4 cases suffered from vena cava tumor thrombi with 3 staged Mayo Ⅲ and 1 Mayo Ⅳ.7 cases with paraneoplastic syndromes were contra-indicated for surgery due to poor ECOG performance score （with score 3 in 3 cases and 2 in 4 cases）.4 cases received Sorafinib 400mg po bid and the other 4 Sunitinib 50 mg po qd,4 weeks on and 2 weeks off,with duration of 8-12 weeks.Medical therapy ceased 6 to 16 days （median 12 days） before operation.Results Patients with neoadjuvant therapy experienced good toleration.The 7 cases with poor ECOGs improved during medical therapy.The tumor sizes in the bilateral lesions shrunk remarkably.All 7 patients received surgery：3 radical nephrectomies,4 nephrectomies and resections of Vena Caval tumor thrombus,and 1 bilateral lesions underwent nephron sparing surgery.Operations were successful though with mild to moderate adhesion,and the blood loss ranged from 120 to 500 ml,with averaged of 280 ml.Pathologic results were clear-cell renal carcinomas.All incisions were

关 键 词：酪氨酸激酶抑制剂靶向药物 高危肾癌 新辅助治疗 副肿瘤综合征 

分 类 号：R737.11[医药卫生—肿瘤]