新型酪氨酸激酶抑制剂药物对肾癌并下腔静脉瘤栓的疗效及机器人手术策略影响  

Efficacy of newer-drugs of tyrosine kinase inhibitor in renal cell carcinoma with inferior vena cava tumor thrombus and the impact on robotic-surgery strategy

作　　者：郅彬 任选义 于栓宝 王声政[3] 陶金[3] 张雪培[3] Zhi Bin;Ren Xuanyi;Yu Shuanbao;Wang Shengzheng;Tao Jin;Zhang Xuepei(Department of Pharmacy,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Urology,Kaijfeng Central Hospial,Kaifeng 475000,China;Department of Urology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院药学部,郑州450052 [2]开封市中心医院泌尿外科,开封475000 [3]郑州大学第一附属医院泌尿外科,郑州450052

出　　处：《中华实验外科杂志》2024年第3期598-601,共4页Chinese Journal of Experimental Surgery

基　　金：河南省高等学校重点科研项目(22A320028)。

摘　　要：目的探讨新型酪氨酸激酶抑制剂(TKI)在肾癌合并下腔静脉瘤栓的疗效,以及术前靶向治疗对手术策略选择的影响。方法2019年1月至2021年12月,郑州大学第一附属医院应用新型TKI药物靶向治疗+机器人手术的11例肾癌并下腔静脉瘤栓患者资料。男8例,女3例,右侧肾癌9例,左侧2例。中位年龄55(35~69)岁,体质量指数(BMI)中位数22.6(18.6~29.2)kg/m^(2)。靶向治疗前瘤栓Mayo Clinic分级:Ⅱ级3例,Ⅲ级7例,Ⅳ级1例。药物用法:培唑帕尼800 mg/d,或阿昔替尼10 mg/d,口服,28d为1个周期。每隔2个周期行彩色多普勒超声、CT或磁共振(MRI)检查,评估瘤栓水平。记录并统计分析瘤栓切取的手术方式、操作过程和恢复情况。结果10例接受培唑帕尼、1例接受阿昔替尼治疗,5例(45%)瘤栓降级。治疗周期中位数4(2~13)个,2例出现3级及以上药物不良反应。靶向治疗后7例(64%)瘤栓缩短,3例(27%)稳定,1例(9%)瘤栓增长,其长度变化平均值-14.3(-48.1~6.6)mm。11例机器人辅助根治性肾切除联合下腔静脉瘤栓切取手术成功,其中3例Ⅲ级、1例Ⅳ级瘤栓在降级后改变了手术策略。中位随访8(6~32)个月,2例因肾癌转移死亡。结论新型TKI药物对肾癌并下腔静脉瘤栓的疗效较明显,术前靶向治疗可使过半病例的瘤栓缩短,降低手术难度。瘤栓降级后可能改变机器人手术策略,提高患者的安全性。Objective To investigate the efficacy of newer-drugs of tyrosine kinase inhibitor(TKI)on renal cell carcinoma(RCC)with inferior vena cava(IVC)tumor thrombus,and the impact of presurgical targeted molecular therapy(TMT)on surgical strategy.MethodsFrom January 2019 to December 2021,11 cases(8 males and 3 females)of RCC with IVC tumor thrombus treated with newer TKI-drugs followed by robot-assisted surgery in the First Affiliated Hospital of Zhengzhou University were reviewed.Among the patients,9 cases involved the right kidney and 2 cases in the left,the median age was 55(35-69)years,and the median body mass index(BMI)was 22.6(18.6-29.2)kg/m^(2).IVC tumor thrombus levels according to the Mayo clinic classification before TMT were stage-Ⅱin 3 cases,stage-Ⅲin 7 cases and stage-Ⅳin 1 case.The oral method of Pazopannib was 800 mg/d or Axitinib 10 mg/d,28 days as one treatment cycle,and the changes of the IVC thrombus level were compared using color Doppler ultrasound,computed tomography(CT)or magnetic resonance imaging(MRI)every two cycles.The surgical method,operational and recovery process of tumor thrombectomy were recorded and analyzed.ResultsThe presurgical TMT inclued Pazopannib in 10 cases and Axitinib in 1 case,down-staging of the IVC thrombus level occurred in 5(45%)cases.During a median 4(2-13)treatment cycles,grade 3 or higher adverse events were experienced in 2 cases.The length of tumor thrombus decreased in 7(64%)cases,remained stable in 3(27%)cases,enlarged in 1(9%)case,and the mean variation of tumor thrombus length was-14.3(-48.1-6.6)mm.Robot-assisted laparoscopic radical nephrectomy and IVC thrombectomy were completed in 11 cases,the surgical strategy was modified in 3 cases given down-staging from level Ⅲ toⅡand 1 case from level Ⅳ toⅢ.The median follow-up was 8(6-32)months,and 2 cases died of RCC metastases.ConclusionNewer TKI-drugs are effective in the treatment of RCC with IVC tumor thrombus,and presurgical TMT can shorten the tumor thrombus and reduce the operational difficulty in m

关 键 词：肾癌 下腔静脉瘤栓 培唑帕尼 阿昔替尼 疗效 

分 类 号：R737.11[医药卫生—肿瘤]