On the other hand, surgical The Latest
Navitoclax Is Twice The Fun interventions, including cytoreductive nephrectomy and or metastasectomy, have also proven to be beneficial to some extent for patients with AM RCC, in terms of both survival and quality of life. Surgical removal of the majority of tumor burden can be expected to diminish the source of tumor promoting growth factors or immunosuppressive cytokines, although this has not yet been confirmed. Currently, an important concern is that no consensus has been established on the criteria for identifying patients with AM RCC who are most likely to benefit from nephrectomy and or metastasectomy performed at the onset. C reactive protein is an acute phase reactant protein exclusively synthesized by hepatocytes.
The serum concentration of CRP rises as much as 1000 fold in immediate response to cytokines or chemical media tors released in various pathological conditions, includ ing acute inflammation, infection, tissue or cell necrosis, and some malignancies. Several studies have reported that CRP is a useful serum marker for patients with RCC, and elevated serum CRP levels have been shown to be associated with tumor aggressiveness, recurrence, and poor prognosis. However, its clinical utility in AM RCC, particularly in deciding whether to perform surgical interventions at the onset, has not been studied well. We retrospectively investigated the role of CRP as a prog nostic marker for patients with AM RCC. We also explored its usefulness in identifying patients who are most likely to benefit from early nephrectomy.
Methods Patients and treatment Eligibility for the study was defined as the presence of clinical or pathologic T4, nodal or organ metastatic RCC when the condition was first diagnosed. A total of 181 patients who were treated at our hospitals for AM RCC between April 1989 and June 2009 were enrolled in the study. The study was conducted in accordance with the principles espoused by the Declaration of Helsinki and all local regulations. The study protocol was approved by the institutional ethics committee of the Yokohama City University Hospital. Among 181 AM RCC patients, 18 patients underwent potentially curative surgeries, i. e, radical nephrectomy concomitant with adjacent organ resection and or total metastasect omy. On the other hand, 111 patients underwent cytoreductive nephrectomy, while the remaining 52 did not undergo nephrectomy and received only medical treatment.
Further, 120 of the 129 patients who underwent any kind of nephrectomy also received postoperative im munotherapy, including IFN and or IL 2. Among the 52 patients who did not undergo nephrectomy, 42 received immunotherapies. Molecular targeting agents, in cluding sorafenib, sunitinib, and or everolimus, were administered to 7 patients after 2008.
No formal statistical comparison of toxicities or complications was performed due to small numbers of events. All analyses were performed using SPSS version 18. Results Fifty one eligible patients underwent 72 curative resec tions for pulmonary metastases. Table 1 shows the base line characteristics of eligible patients. Of 51 patients in our selleck chem cohort, 38 received neoadjuvant and or adju vant chemotherapy relating to their pulmonary resection. In those with no metastatic disease at diagnosis, the me dian DFI was 24. 1 months for the whole cohort 20. 5 months in the peri operative chemotherapy group and 27. 5 months in the surgery alone group. How ever, 11 38 patients in the CS group presented with synchronous metastases at the time of diagnosis.
Forty five patients had CEA levels performed pre thoracotomy, with an elevated result in only 9 patients. 18FDG PET was performed in 45 patients with only 8 PET scans demonstrating no FDG avidity in the lung lesions. The timing of the PET scan did not affect FDG avidity, even in those undergoing neoadjuvant chemotherapy. Table 2 shows the comparisons among CT, PET and sub sequent histology. Concordance with number of con firmed pulmonary metastases diagnosed histologically was higher in PET than CT for those with FDG avid lesions. The median size of the largest lesion was higher in the PET positive group compared to PET negative group. Chemotherapy Of the 38 patients who underwent peri operative systemic therapy, 36 received it with their initial T resection, while 2 patients only received chemotherapy with subsequent resections.
Table 3 shows details of peri operative chemotherapy. Nine patients received tar geted biological agents combined with neoadjuvant chemotherapy. All targeted biological treatments were administered in combination with an oxaliplatin or irinotecan based chemotherapy doublet. Post operative chemotherapy plus targeted therapy was given to all patients receiving bevacizumab and 1 patient who received neoadjuvant cetuximab. In this cohort of 38 patients, chemotherapy was delivered in a total of 49 resections. most commonly peri operatively, with neoadjuvant alone given in 17 resec tions and adjuvant alone after 10 resections. Seven patients who underwent multiple pulmonary resections received no systemic peri operative treatment for at least 1 of these resections.
The median number of chemother apy cycles administered was 4 pre operatively and 5 post operatively. Of 30 patients who received neoadjuvant chemotherapy, 8 developed treatment related complications. Post operative chemotherapy related complica tions occurred more frequently, in 14 patients undergo ing adjuvant chemotherapy. None of the CT scans performed following chemotherapy demonstrated fibrotic changes or pneumonitis suggestive of chemotherapy related lung toxicity.