转移性非透明细胞肾细胞癌靶向治疗的临床观察  

Clinical study of targeted therapy in the treatment of metastatic non-clear cell renal cell carcinoma

作　　者：张桂铭[1] 朱耀[1] 顾伟杰[1] 王弘恺[1] 万方宁[1] 张海梁[1] 施国海[1] 秦晓健[1] 马春光[1] 叶定伟[1] 

机构地区：[1]复旦大学附属肿瘤医院泌尿外科复旦大学上海医学院肿瘤学系,上海200032

出　　处：《中华泌尿外科杂志》2015年第3期179-182,共4页Chinese Journal of Urology

基　　金：国家自然科学基金（81370073）

摘　　要：目的 探讨转移性非透明细胞肾细胞癌（non-clear cell renal cell carcinoma,nccRCC）患者应用靶向药物治疗的效果和不良反应. 方法 回顾性分析2006年12月至2014年5月373例接受靶向药物治疗的转移性肾癌患者的临床资料.透明细胞癌（clear cell renal cell carcinoma,ccRCC）组317例,男233例,女84例.中位年龄59岁.Fuhrman分级：Ⅰ级6例、Ⅱ级58例、Ⅲ级102例、Ⅳ级82例、未分级69例.美国东部肿瘤协作组体力状况评分：0分260例、1分50例、2分7例.既往行细胞因子治疗86例,未行231例.nccRCC组56例,男45例,女11例.中位年龄51岁.其中转移性乳头状肾细胞癌29例,其他病理类型27例.Fuhrman分级：Ⅰ级2例、Ⅱ级5例、Ⅲ级8例、Ⅳ级8例、未分级33例.美国东部肿瘤协作组体力状况评分：0分52例、1分4例.既往行细胞因子治疗17例,未行39例.靶向药物采用索拉非尼（400 mg,2次/d,连续服药）或舒尼替尼（50 mg/d,连续服药4周,停药2周方案）.采用Kaplan-Meier分析绘制生存曲线,Log-rank检验分析两组患者生存曲线的差异.观察两组治疗后的不良反应发生情况. 结果 本组373例均接受≥1个周期的靶向药物治疗.随访2.7 - 79.9个月,中位随访时间34.3个月.ccRCC组中位随访时间为36.6个月,nccRCC组为18.5个月.ccRCC组1、2、3年生存率分别为90.2％、47.9％、24.6％,nccRCC组1年生存率为60.7％,仅1例总生存时间＞2年,两组比较差异有统计学意义（P＜0.05）.nccRCC组中29例转移性乳头状肾细胞癌患者的中位随访时间为18.1个月,1年生存率为51.7％,总体预后明显低于ccRCC患者.两组的常见不良反应均为乏力、手足综合征、腹泻、恶心、皮疹、高血压等,发生率差异无统计学意义（P＞0.05）. 结论 转移性nccRCC患者靶向药物治疗具有一定的疗效,但预后差于ccRCC患者.不良反应多可耐受.Objective To evaluate the efficacy and side effects of targeted therapy in the treatment of metastatic non-clear cell renal cell carcinoma （nccRCC）.Methods Data of patients with metastatic renal cell carcinoma （RCC） who received sorafenib （400 mg,twice one day） or sunitinib （50 mg/d,4 weeks on/2 weeks off） as the first-line targeted therapy from Dec.2006 to May.2014 were analyzed retrospectively.Pathological diagnosis indicated 317 clear cell RCC （ccRCC） and 56 nccRCC （29 papillary RCC and 27 other subtypes）.Kaplan-Meier method was used to assess overall survival （OS）,and log-rank test was performed to compare the difference of median follow-up between the two groups.Side effects were also documented and analyzed in all the patients.Results The follow-up period was 2.7 to 79.9 mon （median：34.3 mon） in the whole group,among which the median follow-up was 36.6 mon in metastatic ccRCC patients and 18.5 mon in nccRCC patients,respectively.The one,two and three-year survival rate in metastatic ccRCC patients were 90.2%,47.9% and 24.6%,respectively.The one-year survival rate in metastatic nccRCC patients was 60.7%,and only one patient survived over two years.Compared with ccRCC patients,those with nccRCC showed poorer prognosis （P〈0.01）.In patients with metastatic papillary RCC,the median follow-up was 18.1 mon and the one-year survival rate was 51.7%,which was worse than those with other subtypes.Analogous to ccRCC,common side effects experienced by nccRCC patients were fatigue,hand-foot syndrome,diarrhea,nausea,rash and hypertension,and there was no significant difference between the two groups （P〉0.05）.Conclusions Targeted therapy is efficient in the treatment of metastatic nccRCC patients and the side effects are reversible,although the prognosis is poorer compared with ccRCC.

关 键 词：转移性肾癌 透明细胞癌 非透明细胞癌 靶向治疗 

分 类 号：R737.11[医药卫生—肿瘤]