背景:在接受肾细胞癌(RCC)脊柱手术的患者中,我们试图:(1)描述术后靶向全身治疗和放疗(RT)的模式,(2)比较接受靶向全身治疗的患者与未接受靶向全身治疗的患者的围手术期结局,和(3)评估靶向全身治疗和/或RT对总生存期(OS)和局部复发(LR)的影响。
方法:单一机构,我们对2010~2021年接受脊柱手术治疗转移性RCC患者进行了回顾性队列研究.治疗组单纯RT,单独的靶向系统治疗,由RT和靶向全身治疗组成的双重治疗,也没有治疗。多变量Cox回归控制年龄,种族,性别,保险,术前靶向全身治疗。
结果:49例患者接受了RCC的脊柱手术。术后,4例患者(8%)单独接受RT,19(38.8%)单纯的靶向全身治疗,12(24.5%)双重治疗,和13(28.6%)。所有组的人口统计学相似,术前Karnofsky表现评分(P=0.372),肿瘤大小(P=0.413),再入院(P=0.884),并发症(P=0.272),Karnofsky绩效得分(P=0.466),末次随访时改良麦考密克量表(P=0.980)。与其他疗法相比,双重疗法的1年生存率更高(83.3%)。与其他治疗相比,双重治疗患者的OS明显更长(log-rank;P=0.010)。多因素Cox回归(HR=0.08,95%CI=0.02-0.31,P<0.001)显示与其他治疗相比,双重治疗的OS更长。7名患者(14.3%)出现LR,组间与LR的时间相似(对数秩;P=0.190)。
结论:在接受脊柱转移性手术治疗的患者中,与其他疗法相比,术后双重疗法显示显著更高的1年生存率和OS.
结论:转移性肾癌的多学科治疗是必要的,以确保及时实施靶向全身治疗和RT以改善预后。
方法:
BACKGROUND: In patients undergoing spine surgery for renal cell carcinoma (RCC), we sought to: (1) describe patterns of postoperative targeted systemic therapy and radiotherapy (RT), (2) compare perioperative outcomes among those treated with targeted systemic therapy to those without, and (3) evaluate the impact of targeted systemic therapy and/or RT on overall survival (OS) and local recurrence (LR).
METHODS: A single-institution, retrospective cohort study of patients undergoing spine surgery for metastatic RCC from 2010 to 2021 was undertaken. Treatment groups were RT alone, targeted systemic therapy alone, dual therapy consisting of RT and targeted systemic therapy, and neither therapy. Multivariable Cox regression controlled for age, race, sex, insurance, and preoperative targeted systemic therapy.
RESULTS: Forty-nine patients underwent spine surgery for RCC. Postoperatively, 4 patients (8%) received RT alone, 19 (38.8%) targeted systemic therapy alone, 12 (24.5%) dual therapy, and 13 (28.6%) neither. All groups were similar in demographics, preoperative Karnofsky Performance Score (P = 0.372), tumor size (P = 0.413), readmissions (P = 0.884), complications (P = 0.272), Karnofsky Performance Score (P = 0.466), and Modified McCormick Scale (P = 0.980) at last follow-up. Higher 1-year survival was found in dual therapy (83.3%) compared with other therapies. OS was significantly longer in patients with dual therapy compared with other therapies (log-rank; P = 0.010). Multivariate Cox regression (HR = 0.08, 95% CI = 0.02-0.31, P < 0.001) showed longer OS in dual therapy compared with other therapies. Seven patients (14.3%) experienced LR, and a similar time to LR was found between groups (log-rank; P = 0.190).
CONCLUSIONS: In patients undergoing metastatic spine surgery for RCC, postoperative dual therapy demonstrated significantly higher 1-year survival and OS compared with other therapies.
CONCLUSIONS: Multidisciplinary management of metastatic RCC is necessary to ensure timely implementation of targeted systemic therapy and RT to improve outcomes.
METHODS: