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目的探讨靶向药物治疗肾细胞癌(RCC)合并下腔静脉癌栓的可行性和有效性。方法回顾性分析上海长海医院泌尿外科2013年11月—2014年2月收治的单侧RCC合并下腔静脉癌栓行靶向药物治疗的4例患者的临床资料。4例患者均伴有不同程度的下腔静脉癌栓,按照美国梅奥医学中心的癌栓分类标准,患者癌栓分级均为Ⅱ级。因考虑癌栓体积大、腔静脉壁有受侵可能,初始均未采取手术治疗。4例患者均服用酪氨酸激酶抑制剂治疗,并每3个月复查胸部和双肾CT,其中2例患者于靶向治疗后3个月行肾癌根治手术。结果 4例患者肿瘤和癌栓在行靶向药物治疗3个月后均有不同程度缩小,2例行肾癌根治手术完整切除肿瘤和癌栓,2例未行手术(其中1例于用药后15个月癌栓级别由Ⅱ级降至Ⅰ级,左肾肿瘤体积亦明显缩小)。目前4例患者均持续行常规剂量靶向药物治疗。结论 RCC合并下腔静脉癌栓的患者采用靶向药物治疗可以使肿瘤体积缩小,癌栓不同程度缩小或降级,可能增加手术切除机会并降低手术难度。
Objective To investigate the feasibility and effectiveness of targeted drug therapy for renal cell carcinoma (RCC) with inferior vena cava tumor thrombus. Methods The clinical data of 4 patients with unilateral RCC complicated with IVC tumor thrombus treated with targeted drug in Department of Urology, Shanghai Changhai Hospital from November 2013 to February 2014 were retrospectively analyzed. All 4 patients were treated with different degrees of IVC thrombosis. According to the classification criteria of thrombus in Mayo Clinic, the grade of thrombus was grade Ⅱ. Due to consider the large volume of tumor thrombus, vena cava walls may have been affected, the initial did not take surgery. Four patients were treated with tyrosine kinase inhibitors, and thoracic and renal CT were reviewed every three months. Two of the patients underwent radical nephrectomy 3 months after targeted therapy. Results The tumors and tumor thrombus in 4 patients were all reduced to varying degrees after 3 months of targeted therapy. Two patients underwent radical resection of tumor and tumor thrombus with radical nephrectomy, and two patients were not operated (one of them after operation 15 months, the level of tumor thrombus reduced to grade Ⅰ Ⅱ, left kidney tumor volume also significantly reduced). At present, all the 4 patients continue the routine dose-targeted drug therapy. Conclusion Patients with RCC complicated with IVC thrombus can reduce tumor size and reduce or reduce the degree of tumor embolism with targeted drug therapy, which may increase the chance of surgical resection and reduce the difficulty of operation.