Cancer UrologyCancer UrologyОнкоурология1726-97761996-1812Publishing House ABV Press48410.17650/1726-9776-2015-11-3-24-33DIAGNOSIS AND TREATMENT OF URINARY SYSTEM TUMORSДИАГНОСТИКА И ЛЕЧЕНИЕ ОПУХОЛЕЙ МОЧЕПОЛОВОЙ СИСТЕМЫPalliative nephrectomy until targeted therapy of disseminated kidney cancer patientsПаллиативная нефрэктомия до таргетной терапии у больных диссеминированным раком почкиKlimovA. V.КлимовА. В.
Russian Federation
klimov_a@bk.ruVolkovaM. I.ВолковаМ. И.
Russian Federation
ShirokogradV. I.ШирокорадВ. И.
Russian Federation
KalininS. A.КалининС. А.
Russian Federation
PetersM. V.ПетерсМ. В.
Russian Federation
MatveevV. B.МатвеевВ. Б.
Russian Federation
Department of Urology, N. N. Blokhin Russian Cancer Research CenterУрологическое отделение ФГБУ «Российский онкологический центр им. Н. Н. Блохина» Минздрава России24, Kashirskoe Shosse, Moscow 115478, RussiaРоссия, 115478, Москва, Каширское шоссе, 23Moscow City Cancer Hospital Sixty-TwoМосковская городская онкологическая больница № 62 ДЗ г. МосквыStepanovskoe, 27, Istra Settlement, Krasnorgorsky District, Moscow Region 143423, RussiaРоссия, 143423, Московская область, Красногорский район, п / о Степановское, пос. Истра, 27Department of Oncology and Radiotherapy, Faculty of Therapeutics, Russian Research Medical University, Ministry of Health of Russiaкафедра онкологии и лучевой терапии лечебного факультета ГБОУ ВПО «Российский национальный исследовательский медицинский университет им. Н. И. Пирогова» Минздрава России1 Ostrovityanov St., Moscow, 117997, RussiaРоссия, 117997, Москва, ул. Островитянова, 1Department of Oncology, Russian Medical Academy of Postgraduate Education, Ministry of Health of Russiaкафедра онкологии ГБОУ ДПО «Российская медицинская академия последипломного образования» Минздрава России2 / 1, Barrikadnaya St., Moscow 125993, RussiaРоссия, 125993, Москва, ул. Баррикадная, 2/13009201511324332309201523092015https://oncourology.abvpress.ru/oncur/article/view/484

Objective: to assess the role of palliative nephrectomy in disseminated kidney cancer patients planned to undergo targeted antiangiogenic treatment.

Subjects and methods. The investigation included data on 83 patients with T1-4N0 / +M1 disseminated renal cell carcinoma (RCC) who had received at least 2 targeted therapy cycles in 2009 to 2011. In 48 (57.8 %) patients, the treatment was preceded by palliative nephrectomy that was not carried out in 35 (42.2 %). Before starting targeted therapy, all the cases were confirmed to be diagnosed with clear cell RCC, with a sarcomatoid component being in 7 (8.4 %) patients. The median follow-up of all the patients was 21 (12–36) months.

Results. The unremoved affected kidney in disseminated kidney cancer patients receiving targeted antiangiogenic therapy is an independent factor for the poor prognosis of progression-free (odds ratio (OR), 2.4; 95 % confidence interval (CI), 1.2–4.7) and overall (OR, 2.8; 95 % CI, 1.3–6.3) survival. Palliative nephrectomy does not improve the prognosis in patients with a low somatic status, the N+ category, and metastases into the bones and nonregional lymph nodes.

Conclusion. Palliative nephrectomy in the selected patients with disseminated kidney cancer on targeted antiangiogenic therapy increases progression-free and overall survival.

Цель исследования – оценка роли паллиативной нефрэктомии у больных диссеминированным раком почки, которым планируется проведение таргетного антиангиогенного лечения.

Материалы и методы. В исследование включены данные 83 больных диссеминированным почечно-клеточным раком Т1 – Т4N0 / +M1, которые получили не менее 2 курсов анти-VEGF / VEGFR-терапии с 2009 по 2011 г. До начала лечения паллиативная нефрэктомия выполнена 48 (57,8 %) пациентам, в 35 (42,2 %) случаях первичную опухоль не удаляли. До начала таргетной терапии во всех случаях подтвержден диагноз светлоклеточного почечно-клеточного рака (с саркоматоидным компонентом – 7; 8,4 %). Медиана наблюдения за всеми пациентами составила 21 (12–36) мес.

Результаты. Медиана беспрогрессивной (БПВ) и общей выживаемости (ОВ) всех 83 больных на фоне 1-й линии антиангиогенной терапии составила 6,8 (5,3–8,5) и 23,4 (13,8–32,9) мес соответственно. Неудаленная пораженная почка у больных диссеминированным раком почки, получающих таргетную антиангиогенную терапию, – независимый фактор неблагоприятного прогноза БПВ (медиана 3,9 мес против 8,9 мес соответственно; отношения рисков (ОР) 2,4; 95 % доверительный интервал (ДИ) 1,2–4,7) и ОВ (медиана 12,5 мес против 29,1 мес соответственно; ОР 2,8; 95 % ДИ 1,3–6,3).

Выводы. Паллиативная нефрэктомия у отобранных больных диссеминированным раком почки, получающих таргетную антиангиогенную терапию, увеличивает БПВ и ОВ.

disseminated kidney cancertargeted therapypalliative nephrectomyprognostic factorsprogression-free survivaloverall survivalpostoperative complicationsadverse eventstoxicitysomatic statusдиссеминированный рак почкитаргетная терапияпаллиативная нефрэктомияфакторы прогнозабеспрогрессивная выживаемостьобщая выживаемостьпослеоперационные осложнениянежелательные явлениятоксичностьсоматический статус1. Coppin C., Porzsolt F., Autenrieth M. et al. Immunotherapy for advanced renal cell cancer. Cochrane Database Syst Rev 2005, p. CD001425.Coppin C., Porzsolt F., Autenrieth M. et al. Immunotherapy for advanced renal cell cancer. Cochrane Database Syst Rev 2005, p. CD001425.2. Flanigan R.C., Salmon S.E., Blumenstein B.A. et al. Nephrectomy followed by interferon alfa- 2b compared with interferon alfa-2b alone for metastatic renal-cell cancer. N Engl J Med 2001;345:1655–9.Flanigan R.C., Salmon S.E., Blumenstein B.A. et al. Nephrectomy followed by interferon alfa- 2b compared with interferon alfa-2b alone for metastatic renal-cell cancer. N Engl J Med 2001;345:1655–9.3. Mickisch G.H., Garin A., van Poppel H. et al. European Organisation for Research and Treatment of Cancer (EORTC) Genitourinary Group Radical nephrectomy plus nterferonalfa- based immunotherapy compared with interferon alfa alone in metastatic renal-cell carcinoma: a randomised trial. Lancet 2001;358:966–70.Mickisch G.H., Garin A., van Poppel H. et al. European Organisation for Research and Treatment of Cancer (EORTC) Genitourinary Group Radical nephrectomy plus nterferonalfa- based immunotherapy compared with interferon alfa alone in metastatic renal-cell carcinoma: a randomised trial. Lancet 2001;358:966–70.4. Flanigan R.C., Mickisch G., Sylvester R. et al. Cytoreductive nephrectomy in patients with metastatic renal cancer: a combined analysis. J Urol 2004;171:1071–6.Flanigan R.C., Mickisch G., Sylvester R. et al. Cytoreductive nephrectomy in patients with metastatic renal cancer: a combined analysis. J Urol 2004;171:1071–6.5. Coppin C., Le L., Porzsolt F. et al. Targeted therapy for advanced renal cell carcinoma. Cochrane Database Syst Rev 2008;(2):CD006017.Coppin C., Le L., Porzsolt F. et al. Targeted therapy for advanced renal cell carcinoma. Cochrane Database Syst Rev 2008;(2):CD006017.6. Conti S.L., Thomas I.C., Hagedorn J.C. et al.Utilization of cytoreductive nephrectomy and patient survival in the targeted therapy era. Int J Cancer 2014;134:2245–52.Conti S.L., Thomas I.C., Hagedorn J.C. et al.Utilization of cytoreductive nephrectomy and patient survival in the targeted therapy era. Int J Cancer 2014;134:2245–52.7. Escudier B., Bellmunt J., Negrie S. et al. Phase III trial of bevacizumab plus interferon alfa_2a in patients with metastatic renal cell carcinoma (AVOREN): Final analysis of overall survival. J Clin Oncol 2010;28:2144–50.Escudier B., Bellmunt J., Negrie S. et al. Phase III trial of bevacizumab plus interferon alfa_2a in patients with metastatic renal cell carcinoma (AVOREN): Final analysis of overall survival. J Clin Oncol 2010;28:2144–50.8. Rini B., Halabi S., Rosenberg J. et al. Phase III trial of bevacizumab plus interferon alfa versus interferon alfa monotherapy in patients with metastatic renal rell carcinoma: final results of CALGB 90206. J Clin Oncol 2010;28:2137–43.Rini B., Halabi S., Rosenberg J. et al. Phase III trial of bevacizumab plus interferon alfa versus interferon alfa monotherapy in patients with metastatic renal rell carcinoma: final results of CALGB 90206. J Clin Oncol 2010;28:2137–43.9. Motzer R.J., Hutson T.E., Tomczak P. et al. Sunitinib versus interferon alfa in metastatic renal_cell carcinoma. N Engl J Med 2007;356:115–24.Motzer R.J., Hutson T.E., Tomczak P. et al. Sunitinib versus interferon alfa in metastatic renal_cell carcinoma. N Engl J Med 2007;356:115–24.10. Hudes G., Carducci M., Tomczak P. et al. Temsirolimus, interferon alfa, or both for advanced renal–cell carcinoma. N Engl J Med 2007;356:2271–81.Hudes G., Carducci M., Tomczak P. et al. Temsirolimus, interferon alfa, or both for advanced renal–cell carcinoma. N Engl J Med 2007;356:2271–81.11. Escudier B., Eisen T., Stadler W.M. et al. Sorafenib for treatment of renal cell carcinoma: Final efficacy and safety results of the phase III treatment approaches in renal cancer global evaluation trial. J Clin Oncol 2009;27:3312–8.Escudier B., Eisen T., Stadler W.M. et al. Sorafenib for treatment of renal cell carcinoma: Final efficacy and safety results of the phase III treatment approaches in renal cancer global evaluation trial. J Clin Oncol 2009;27:3312–8.12. Sternberg C., Davis I., Mardiak J. et al. Pazopanib in locally advanced or metastatic renal cell carcinoma: results of a randomized phase III trial. J Clin Oncol 2010;28:1061.Sternberg C., Davis I., Mardiak J. et al. Pazopanib in locally advanced or metastatic renal cell carcinoma: results of a randomized phase III trial. J Clin Oncol 2010;28:1061.13. Motzer R.J., Escudier B., Oudard S. et al. Efficacy of everolimus in advanced renal cell carcinoma: a doubleblind, randomized, placebo_controlled phase III trial. Lancet 2008;372:449–56.Motzer R.J., Escudier B., Oudard S. et al. Efficacy of everolimus in advanced renal cell carcinoma: a doubleblind, randomized, placebo_controlled phase III trial. Lancet 2008;372:449–56.14. Abdollah F., Sun M., Thuret R. et al. Mortality and morbidity after cytoreductive ephrectomy for metastatic renal cell carcinoma: a populationbased study. Ann Surg Oncol 2011;18:2988–96.Abdollah F., Sun M., Thuret R. et al. Mortality and morbidity after cytoreductive ephrectomy for metastatic renal cell carcinoma: a populationbased study. Ann Surg Oncol 2011;18:2988–96.15. Chapin B.F., Delacroix S.E., Culp S.H. et al. Post operative complications from cytoreductive nephrectomy after pre-surgical targeted therapy for metastatic renal cell carcinoma. AUA Annual Meeting, 2011.Chapin B.F., Delacroix S.E., Culp S.H. et al. Post operative complications from cytoreductive nephrectomy after pre-surgical targeted therapy for metastatic renal cell carcinoma. AUA Annual Meeting, 2011.16. Beck J., Procopio G., Bajetta E. et al. Final results of the European Advanced Renal Cell Carcinoma Sorafenib (EU-ARCCS) expandedaccess study: a large open-label study in diverse community settings. Ann Oncol 2011;22(8):1812–23.Beck J., Procopio G., Bajetta E. et al. Final results of the European Advanced Renal Cell Carcinoma Sorafenib (EU-ARCCS) expandedaccess study: a large open-label study in diverse community settings. Ann Oncol 2011;22(8):1812–23.17. Heng Daniel Y.C., Wells J. Connor, Rini Brian I. Cytoreductive nephrectomy in patients with synchronous metastases from renal cell carcinoma: Results from the International Metastatic Renal Cell Carcinoma Database Consortium. Eur Urol 2014;66:704–10.Heng Daniel Y.C., Wells J. Connor, Rini Brian I. Cytoreductive nephrectomy in patients with synchronous metastases from renal cell carcinoma: Results from the International Metastatic Renal Cell Carcinoma Database Consortium. Eur Urol 2014;66:704–10.18. Choueiri T.K., Xie W., Kollmannsberger C. et al.The impact of cytoreductive ephrectomy on survival of patients with metastatic renal cell carcinoma receiving vascular endothelial growth factor targeted therapy. J Urol 2011;185:60–6.Choueiri T.K., Xie W., Kollmannsberger C. et al.The impact of cytoreductive ephrectomy on survival of patients with metastatic renal cell carcinoma receiving vascular endothelial growth factor targeted therapy. J Urol 2011;185:60–6.19. Warren M., Venner P.M., North S. et al. A population-based study examining the effect of tyrosine kinase inhibitors on survival in metastatic renal cell carcinoma in Alberta and the role of nephrectomy prior to treatment. Can Urol Assoc J 2009;3(4):281–9.Warren M., Venner P.M., North S. et al. A population-based study examining the effect of tyrosine kinase inhibitors on survival in metastatic renal cell carcinoma in Alberta and the role of nephrectomy prior to treatment. Can Urol Assoc J 2009;3(4):281–9.20. Heng M., Xie W., Regan M.M. et al. Prognostic factors for overall survival in patients with metastatic renal cell carcinoma treated with vascular endothelial growth factor-targeted agents: results from a large, multicenter study. J Clin Oncol 2009;27:5794–9.Heng M., Xie W., Regan M.M. et al. Prognostic factors for overall survival in patients with metastatic renal cell carcinoma treated with vascular endothelial growth factor-targeted agents: results from a large, multicenter study. J Clin Oncol 2009;27:5794–9.