新辅助分子靶向治疗在肾细胞癌患者治疗中的临床应用研究

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摘要 目的:分析单中心8例肾细胞癌患者术前新辅助靶向治疗的成功经验,探讨靶向药物新辅助治疗的适应证、药物使用方法及手术时机。方法:2009年6月~2013年6月,8例(男5例,女3例,平均年龄49岁)肾细胞癌患者在术前接受了新辅助分子靶向治疗,收集患者的临床资料、靶向治疗方案、疗效及不良反应、手术的选择与时机、围手术期并发症、术后病理学改变及预后等信息。结果:术前诊断双侧肾癌2例、孤立肾癌1例、肾癌伴腔静脉癌栓5例。术前接受索拉非尼400 mg Bid连续给药方案 3例,舒尼替尼50 mg/d,服用4周间歇2周给药方案5例,术前平均接受靶向治疗时间12.5周。主要不良反应与既往文献报道相符,均为1~2级。术前评估病灶或瘤栓均有不同程度缩小,最大径平均缩小21%(10%~32%),数值为1.7(1.0~2.7)cm。所有患者在停药2~3周后接受手术治疗,其中后腹腔镜肾部分切除术3例,肾根治性切除+腔静脉瘤栓取出术5例,术后病理结果均为肾细胞癌。结论:新辅助治疗能够降低肿瘤分期,降低手术难度,增加晚期肾癌的根治性切除率,也增加了患者行保留肾单位手术的机会。同时,靶向治疗并没有显著增加围手术期死亡率及并发症发生风险。

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	郭刚
	蔡伟
	高江平
	马鑫
	董隽
	符伟军
	张旭

关键词 ：肾细胞癌, 靶向治疗, 新辅助治疗

Abstract：Objective:The feasibility and safety of a presurgical treatment approach with Sunitinib or Sorafenib for renal cell carcinoma (RCC) were to be evaluated and its potential ability to reduce the surgical morbidity explored. Methods:Between June 2009 and June 2013, 8 patients were treated with targeted therapy and subsequently underwent resection. Toxicities, surgical complications, and tumor responses were monitored. Results:Five male and three female Rcc patients received the presurgical targeted therapy.The average age was 49 years old.The diagnosis included two bilateral Rcc,one isolated Rcc and five Rcc with a level Ⅲ/Ⅳ vena cava tumour thrombus.Three patients received Sorafenib 400 mg Bid and five received Sunitinib 50 mg Qd 4/2 weeks schedule.The average presurgical treatment time was 12.5 weeks.The main adverse reaction(AE) included thrombopenia, leucopenia, hand-foot reaction, hypothyroidism and hypertension.The median change in primary renal cell carcinoma tumors was a 21% (10%-32%)decrease, corresponding to a median absolute reduction of 1.7(1.0-2.7)cm. All patients received drug discontinuance for 2-3 weeks before operation.Three patients received laparoscopic nephron sparing surgery and five patients received nephrectomy and vena cava tumour thrombus removal surgery.All patients had viable renal cell carcinoma in the surgical specimen. Conclusions:The administration of preoperative targeted therapy can impact the size and density of the primary tumor and appears safe and feasible. More Rcc patients can receive nephron-sparing partial nephrectomy. Also, presurgical targeted therapy may not increase the death rate and complication rate.

Key words： renal cell carcinoma targeted therapy neoadjuvant therapy

收稿日期: 2013-08-26

ZTFLH:

R737.2

通讯作者: 张旭,xzhang@foxmail.com

引用本文:

郭刚, 蔡伟, 高江平, 马鑫, 董隽, 符伟军, 张旭. 新辅助分子靶向治疗在肾细胞癌患者治疗中的临床应用研究[J]. 微创泌尿外科杂志, 2013, 2(5): 347-350.
Guo Gang, Cai Wei, Gao Jiangping, Ma Xin, Dong Jun, Fu Weijun, Zhang Xu. Presurgical targeted therapy with tyrosine kinase inhibitors for advanced renal cell carcinoma. JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2013, 2(5): 347-350.

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http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/abstract/abstract1067.shtml 或 http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/Y2013/V2/I5/347

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