机构地区：[1]中山大学肿瘤防治中心、华南肿瘤学国家重点实验室肿瘤医学协同创新中心泌尿外科,广州510060 [2]中山大学肿瘤防治中心、华南肿瘤学国家重点实验室肿瘤医学协同创新中心放疗科,广州510060 [3]中山大学肿瘤防治中心、华南肿瘤学国家重点实验室肿瘤医学协同创新中心微创介入科,广州510060
出 处：《中华泌尿外科杂志》2023年第1期1-6,共6页Chinese Journal of Urology
摘 要：目的 探讨肾癌术后局部复发不同治疗模式的疗效。方法 回顾性分析2001年10月至2020年7月中山大学肿瘤防治中心收治的106例肾癌术后局部复发患者的资料。男77例,女29例。中位年龄51(40,60)岁。原发肿瘤行根治性肾切除术90例,肾部分切除术16例;病理诊断为透明细胞癌54例,非透明细胞癌52例;T_(1~2)期53例,T_(3~4)期53例。肾原发灶手术至肿瘤局部复发的中位时间为14.8(7.3,35.8)个月。复发病灶中位直径为3.2(2.0,6.3)cm,中位数量为2(1,4)个。复发部位分为肾窝内复发33例,肾周合并区域淋巴结复发38例,腹腔内其他区域复发35例。美国东部肿瘤协作组(ECOG)评分0~1分84例,2分22例。根据患者接受的治疗方式不同分为单纯药物治疗组(采用靶向药物治疗或免疫治疗)和局部治疗组(局部治疗联合或不联合药物治疗,局部治疗方式包括手术切除、冷冻消融或放疗)。采用Kaplan-Meier法绘制生存曲线,log-rank检验比较两组患者无进展生存时间(PFS)和总生存时间(OS),采用Cox等比例风险模型对不同治疗模式的预后因素进行单因素和多因素分析。结果 本研究106例,单纯药物治疗组33例,局部治疗组73例。单纯药物治疗组中,29例(87.9%)接受单纯靶向药物治疗,4例(12.1%)接受靶向药物联合免疫治疗。局部治疗组中,34例(46.6%)接受手术(转移瘤切除或冷冻消融)治疗,39例(53.4%)接受立体定向放疗(SBRT);73例中62例(84.9%)同时接受一线靶向药物治疗,其中58例(93.5%)接受单纯靶向药物治疗,4例(6.5%)接受靶向药物联合免疫治疗。106例中位随访时间29.0(15.4,45.9)个月,64例肿瘤进展,包括28例肿瘤相关死亡。总体中位PFS和OS分别为15.6(7.1,35.2)个月和66.9(37.8,未达到)个月。单纯药物治疗组和局部治疗组的中位PFS分别为7.6(5.0,17.2)个月和22.2(9.6,63.9)个月(P=0.001),中位OS分别为45.7(23.4,62.8)个月和71.0(50.6,未达到)个月,2年总生存率分别为70.6%Objective To investigate the efficacy of different treatment modes for locoregional recurrence after nephrectomy in patients with renal cell carcinoma.MethodsA total of 106 patients with locoregional recurrence after nephrectomy without distant metastasis(77 males and 29 females)admitted to Sun Yat-sen University Cancer Center from October 2001 to July 2020 were retrospectively analyzed.The median age was 51(40,60)years old.Radical nephrectomy was performed in 90 patients with primary tumor and partial nephrectomy was performed in 16 patients.Pathological diagnosis showed that 54 cases were clear cell carcinoma and 52 cases were non-clear cell carcinoma.53 cases were in stage T_(1-2)and 53 cases in stage T_(3-4).The median diameter of recurrent lesions was 3.2(2.0,6.3)cm,and the median number was 2(1,4).The recurrence sites were divided into renal fossa recurrence(33 cases),renal fossa±retroperitoneal lymph node recurrence(38 cases),and intra-abdominal spread(35 cases).The median duration from primary surgery to local recurrence was 14.8(7.3,35.8)months.Two treatment groups were identified as systemic therapy alone(Group A)and local therapy with or without systemic therapy(Group B).The Kaplan-Meier method was used to compare the progression free survival(PFS)and overall survival(OS)between Group A and Group B.The Cox model was used to perform univariate and multivariate analysis.ResultsOf all the 106 patients,33 patients were in Group A and 73 patients were in Group B.In Group A,29 patients(87.9%)received targeted therapy,and 4 patients(12.1%)received targeted therapy combined with immunotherapy.In Group B,34 patients(46.6%)received surgery or ablation and 39 patients(53.4%)received SBRT,of which 62 patients(84.9%)received concurrent systemic therapy.Among them,58 patients(93.5%)received targeted therapy,and 4 patients(6.5%)received targeted therapy combined with immunotherapy.The median follow-up period was 29.0(15.4,45.9)months,64 patients progressed on tumor including 28 patients died.The median PFS and OS we
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