CAJ | 학술논문

目的报告1例多发转移性肾癌患者舒尼替尼治疗后行减瘤手术的成功经验,探讨新辅助治疗的有效性和治疗方案. 方法患者,男,51岁.因无痛性肉眼血尿1周于2010年8月入院.CT检查示左肾下极肿瘤大小6.6 cm ×6.3 cm,左肾静脉瘤栓形成,肾门可见肿大淋巴结,局部浸润,伴肺和右侧胫骨转移(T3bN1M1).穿刺活检证实为肾透明细胞癌.采用50 mg舒尼替尼4/2方案治疗2个周期,停药2周后行减瘤手术.术前再次对原发肿瘤和转移灶进行影像学评估,术后随访.结果新辅助治疗后,CT复查示左肾肿瘤大小5.1 cm ×4.4 cm(最大径线缩小23％),肾静脉瘤栓体积缩小,局部浸润情况好转,肺转移灶基本消失,右胫骨转移灶无进展.按照RECIST标准判断为疾病稳定.2010年12月成功行减瘤性肾切除术.病理报告肾透明细胞癌Ⅱ级,瘤内有大片坏死,瘤栓局限于肾静脉内.术后6个月复查,原发灶处未见肿瘤复发,肺转移灶完全消失,右胫骨转移灶无进展.随访至今20个月,未见肿瘤复发及其他远处转移灶,肿瘤控制效果为部分缓解. 结论舒尼替尼新辅助治疗能够使原发肿瘤降期,为减瘤手术创造机会,最终提高患者的总体生存期.
목적 보고1례다발전이성신암환자서니체니치료후행감류수술적성공경험,탐토신보조치료적유효성화치료방안. 방법 환자,남,51세.인무통성육안혈뇨1주우2010년8월입원.CT검사시좌신하겁종류대소6.6 cm ×6.3 cm,좌신정맥류전형성,신문가견종대림파결,국부침윤,반폐화우측경골전이(T3bN1M1).천자활검증실위신투명세포암.채용50 mg서니체니4/2방안치료2개주기,정약2주후행감류수술.술전재차대원발종류화전이조진행영상학평고,술후수방.결과 신보조치료후,CT복사시좌신종류대소5.1 cm ×4.4 cm(최대경선축소23％),신정맥류전체적축소,국부침윤정황호전,폐전이조기본소실,우경골전이조무진전.안조RECIST표준판단위질병은정.2010년12월성공행감류성신절제술.병리보고신투명세포암Ⅱ급,류내유대편배사,류전국한우신정맥내.술후6개월복사,원발조처미견종류복발,폐전이조완전소실,우경골전이조무진전.수방지금20개월,미견종류복발급기타원처전이조,종류공제효과위부분완해. 결론 서니체니신보조치료능구사원발종류강기,위감류수술창조궤회,최종제고환자적총체생존기.
Objective To report a multiple metastatic renal cell carcinoma (RCC) case successfully treated with cytoreductive nephrectomy after neoadjuvant Sunitinib,and discuss the efficacy and treatment regime of neoadjuvant targeting therapy.Methods A 51 years man presented with painless gross hematuria for one week and admitted into our hospital in August 2010.Abdominal CT demonstrated a 6.6 cm ×6.3 cm left lower pole renal tumor associated with renal vein tumor thrombus,bulky hilar lymph nodes and extensive local invasion.The patient was also found to have lung and right tibial metastasis.The clinical stage was T3bN1 M1.Percutaneous biopsy confirmed clear cell renal carcinoma.Neoadjuvant Sunitinib 50 mg daily was administered with 4 weeks on,2 weeks off schedule for two cycles.Cytoreductive nephrectomy was preformed 2 weeks after discontinuation of neoadjuvant Sunitinib.Imaging evaluation was performed to assess the primary tumor and metastatic sites.The patient was followed up till present.Results After two cycles of neoadjuvant treatment,CT scan revealed 23％ size reduction of left renal tumor to 5.1 cm ×4.4 cm,renal vein tumor thrombus regression,local perirenal invasion improvement,lung metastasis resolution and static right tibial metastasis.According to RECIST criteria,the objective response was stabilization of disease (SD).Cytoreductive nephrectomy was successfully performed to remove the primary tumor in December 2010.Pathology revealed Fuhrman Ⅱ renal cell carcinoma with major necrosis in primary tumor and thrombus localized in renal vein.During 6 months of post-operative follow-up,there was no local recurrence,lung metastasis had vanished completely and tibial metastasis had not progressed.Local recurrence and other distant metastasis were not demonstrated in 20mon follow-up till now.Disease control of this patient was partial response (PR) by RECIST.Conclusions Neoadjuvant Sunitinib treatment could result in downstaging of primary tumor and facilitate cytoreductive nephrectomy,thus eventually increase patient overall survival.