Cytoreductive Nephrectomy in Patients with Synchronous Metastases from Renal Cell Carcinoma: Results from the International Metastatic Renal Cell Carcinoma Database Consortium

Background

The benefit of cytoreductive nephrectomy (CN) for overall survival (OS) is unclear in patients with synchronous metastatic renal cell carcinoma (mRCC) in the era of targeted therapy.

Objective

To determine OS benefit of CN compared with no CN in mRCC patients treated with targeted therapies.

Design, setting, and participants

Retrospective data from patients with synchronous mRCC (n = 1658) from the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) were used to compare 982 mRCC patients who had a CN with 676 mRCC patients who did not.

Outcome measurements and statistical analysis

OS was compared and hazard ratios (HRs) adjusted for IMDC poor prognostic criteria.

Results and limitations

Patients who had CN had better IMDC prognostic profiles versus those without (favorable, intermediate, or poor in 9%, 63%, and 28% vs 1%, 45%, and 54%, respectively). The median OS of patients with CN versus without CN was 20.6 versus 9.5 mo (p < 0.0001). When adjusted for IMDC criteria to correct for imbalances, the HR of death was 0.60 (95% confidence interval, 0.52–0.69; p < 0.0001). Patients estimated to survive <12 mo may receive marginal benefit from CN. Patients who have four or more of the IMDC prognostic criteria did not benefit from CN. Data were collected retrospectively.

Conclusions

CN is beneficial in synchronous mRCC patients treated with targeted therapy, even after adjusting for prognostic factors. Patients with estimated survival times <12 mo or four or more IMDC prognostic factors may not benefit from CN. This information may aid in patient selection as we await results from randomized controlled trials.

Patient summary

We looked at the survival outcomes of metastatic renal cell carcinoma patients who did or did not have the primary tumor removed. We found that most patients benefited from tumor removal, except for those with four or more IMDC risk factors.     

Introduction—Targeting the lesion,not the organ

The current diagnostic and therapeutic strategy for localized prostate cancer is not working. In fact, it is severely flawed and, as such, fraught with controversy. Our current strategy has arisen from the imprecision of our diagnostic pathway. We do not know where the cancer is, so we subject the prostate to randomly placed needles in the hope of hitting the tumor. This leads to overdiagnosis, underdiagnosis, missclassification of risk and overtreatment and undertreatment. If we do find cancer, we usually subject the entire prostate to radiotherapy or surgery, which damages the surrounding structures—neurovascular bundles, external urinary sphincter, rectum, and bladder neck. Multiparametric magnetic resonance imaging, coupled with an intensive sampling strategy (targeted biopsies), might be able to rule out clinically significant lesions with a negative predictive value in the order of 90% to 95%. Focal therapy certainly leads to less genitourinary and rectal side effects. Current data from more than 3,000 men treated internationally show that incontinence after focal therapy is 0% to 5% (radical therapy can lead to incontinence in 15%–20%) whereas erectile dysfunction occurs in 5% to 10% of men with good baseline function (radical therapy rates vary between 30% and 60%). Early to medium cancer control using biopsies after treatment shows between 80% and 90% of patients have a successful treatment, with 10% to 15% of men requiring redo-treatment with minimal additional morbidity.     

Functional differentiation of cytotoxic cancer drugs and targeted cancer therapeutics

There is no nationally or internationally binding definition of the term “cytotoxic drug” although this term is used in a variety of regulations for pharmaceutical development and manufacturing of drugs as well as in regulations for protecting medical personnel from occupational exposure in pharmacy, hospital, and other healthcare settings. The term “cytotoxic drug” is frequently used as a synonym for any and all oncology or antineoplastic drugs. Pharmaceutical companies generate and receive requests for assessments of the potential hazards of drugs regularly – including cytotoxicity. This publication is intended to provide functional definitions that help to differentiate between generically-cytotoxic cancer drugs of significant risk to normal human tissues, and targeted cancer therapeutics that pose much lesser risks. Together with specific assessments, it provides comprehensible guidance on how to assess the relevant properties of cancer drugs, and how targeted therapeutics discriminate between cancer and normal cells. The position of several regulatory agencies in the long-term is clearly to regulate all drugs regardless of classification, according to scientific risk based data. Despite ongoing discussions on how to replace the term “cytotoxic drugs” in current regulations, it is expected that its use will continue for the near future.     

靶向药物联合化疗治疗晚期非小细胞肺癌的临床分析

目的 分析研究靶向药物联合化疗治疗晚期非小细胞肺癌（NSCLC）的疗效.方法 选取2011-2012年我院收治的晚期NSCLC患者46例,将其随机划分为两组.甲组采用常规的化疗药物治疗,乙组在给予常规化疗基础上使用靶向药物治疗,比较两组治疗效果.结果 甲组临床疗效优于乙组,差异有统计学意义（P＜0.05）;两组患者血红蛋白、血小板、白细胞下降及皮疹、消化道反应发生率比较差异无统计学意义（P＞0.05）.结论 给予晚期NSCLC患者采用靶向药物联合化疗治疗,可显著提高临床治疗效果.     

针对性护理干预对神经外科患者术后医院感染的控制效果

目的探讨针对性护理干预对神经外科患者术后医院感染的控制效果。方法选择本院神经外科手术患者367例,分为观察组（n=186）和对照组（n=181）,对照组实施常规护理,观察组在常规护理基础上,采用针对性的护理干预。比较两组的医院感染发生率、低氧血症发生率及护理满意度。结果观察组医院感染发生率为5．9％,显著低于对照组的12．7％,差异有统计学意义（P〈0.05）。观察组低氧血症发生率为9．7％,显著低于对照组的21．5％,差异有统计学意义（P〈0.05）。观察组护理满意度为84．4％,显著高于对照组的61．3％．差异有统计学意义（P〈0.05）。结论采用针对性的护理干预,可有效降低神经外科患者术后医院感染的发生率及低氧血症发生率,提高患者的护理满意度。     

针对性护理干预对糖尿病患者服药依从性的影响

目的探讨针对性护理干预对糖尿病患者服药依从性的影响。方法将62例糖尿病患者按不同护理干预方法分为两组,对照组30例,采用常规护理干预,干预组32例,采用针对性护理干预,于预3个月后,比较两组的服药依从性、血糖控制情况、护理满意度。结果干预组的依从率为87．50％,高于对照组的66．67％,差异有统计学意义（P〈0．05）。两组治疗后的F13G比较差异无统计学意义（P〉0．05）;干预组治疗后的2hPBG低于对照组,差异有统计学意义（P〈0．05）。干预组的护理满意度明显高于对照组,差异有统计学意义（P〈0．05）。结论对在职糖尿病患者施行针对性护理干预的效果显著,能明显提高服药依从性,值得临床推广应用。     

肝动脉化疗栓塞联合射频消融和免疫靶向治疗术后复发的肝细胞癌患者近远期疗效研究*

目的 探讨采用肝动脉化疗栓塞(TACE)联合射频消融(RFA)和免疫靶向治疗术后复发的肝细胞癌(HCC)患者的疗效。方法 2014年8月～2018年4月我院诊治的术后复发性HCC患者150例,采用随机数字表法将患者分为对照组75例和观察组75例,分别给予TACE联合RFA治疗或在此基础上给予抗程序性细胞死亡蛋白-1(PD-1)抗体和阿帕替尼治疗,采用实体瘤mRESIST标准评估临床疗效,使用流式细胞仪测定外周血T细胞亚群,采用Kaplan-Meier法比较生存率。结果 在治疗后3 m,观察组有效率为81.3%,显著高于对照组的53.3%(P<0.05);观察组外周血CD3⁺、CD4⁺细胞百分比和CD4⁺/CD8⁺细胞比值分别为(68.2±6.8)%、(45.9±4.7)%和(1.8±0.3),显著高于对照组【分别为(56.5±6.1)%、(33.3±4.5)%和(1.3±0.2),P<0.05】,而CD8⁺细胞百分比为(22.5±1.8)%,显著低于对照组【(28.3±1.4)%,P<0.05】;观察组I/II级不良反应发生率为73.3%,显著高于对照组的32.0%(P<0.05);观察组1 a生存率为49.3%,显著高于对照组的30.7%(P<0.05)。结论 采用TACE联合RFA和免疫靶向治疗能够有效提高复发性HCC患者的近期临床疗效,可能与提高了机体免疫功能,抑制了肿瘤血管生成有关。     

针对性护理干预在神经内科气管切开患者中的应用

目的：探讨针对性护理干预在神经内科气管切开患者中的护理效果。方法：回顾性总结分析本院在2010年7月-2013年7月期间收治的90例患者的临床病例资料,按照随机数字表法分为两组,分别采用常规护理和针对性护理干预,比较两组患者的临床护理效果。结果：观察组患者术后感染率及HAMA评分均优于对照组,两组比较差异均有统计学意义（P〈0．05）。结论：对神经内科患者进行针对性护理干预能够有效改善患者术后各项临床症状,有助于临床治疗效果的巩固,具有临床推广应用价值。