Abstract
Objective. To increase the effectiveness of drug treatment via systemic therapy (ST) in combination with incomplete cytoreductive interventions – incomplete metastasectomy (iME).Materials and methods. Three centers took part in the study. All 147 patients with mRCC received anticancer drug therapy. Part of them (n = 47) underwent surgery (iME) before or together with anticancer treatment, where iME meant complete metastasis excision within one organ with residual tissue in other organs (research group). Control group (n = 100) included patients who received only systemic antitumor treatment. Primary control point was overall survival (OS), secondary – time to progression.Results. Median OS in combined treatment group was 32 months, while in control group – 29 months (p = 0.21). When analyzing surgical stage in combined treatment, OS was statistically more significant in patients with iME before ST (n = 20) than in patients with two parallel treatment schemes: 46 and 31 months, respectively (p = 0.007). When analyzing metastases localization, it was found that iME is effective for metastases to distant lymph nodes and adrenal gland. Adrenalectomy (p = 0.03) and lymphadenectomy (p = 0.04) showed higher results than ST: 17 and 15 months versus 6 month, respectively. IME in patients with poor prognosis did not reveal any advantages: median OS reached 7 months, which was significantly inferior to the favorable prognosis group, where median OS was 25 months (p = 0.03).Conclusion. IME can be used as a part of combined treatment in mRCC patients. It should be considered as the first treatment stage with subsequent ST.
Highlights
It was found that incomplete metastasectomy (iME) is effective for metastases to distant lymph nodes and adrenal gland
Рак почки advantages: median overall survival (OS) reached 7 months, which was significantly inferior to the favorable prognosis group, where median OS was 25 months (p = 0.03)
IME can be used as a part of combined treatment in mRCC patients
Summary
To increase the effectiveness of drug treatment via systemic therapy (ST) in combination with incomplete cytoreductive interventions – incomplete metastasectomy (iME). I. et al Efficacy of incomplete metastasectomy in combination with targeted therapy in metastatic kidney cancer patients. Полное удаление (полная циторедукция) метастатических очагов продлевает жизнь больных мПКР, при этом медиана общей выживаемости (ОВ) составляет 55–60 мес [5]. Авторы определили нЦР, или неполную метастазэктомию, как полное радикальное иссечение измеряемого метастатического очага / очагов в пределах 1 органа при наличии резидуальной опухолевой ткани в другом / других органе. В исследование не вошли данные о больных мПКР, которым было проведено иссечение метастатического очага в органе при наличии других метастазов в нем же, кроме того, нет сведений о хирургических вмешательствах по поводу костных изменений в позвоночнике и плоских костях: авторы исключили их из анализа.
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