Nefrectomía citorreductora diferida en adultos con carcinoma de células renales metastásico y trombo tumoral en vena cava tratados con neoadyuvancia basada en inmunoterapia: revisión sistemática

IF 1.2 4区 医学 Q3 UROLOGY & NEPHROLOGY
E.S. Cruz Peralta , M. González Domínguez , R.J. Salgueiro Ergueta , M.L. Peralta Pedrero
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引用次数: 0

Abstract

Introduction

Renal cell carcinoma (RCC) invades the inferior vena cava (IVC) in 4% to 10% of cases, increasing the risk of surgical complications that affect oncological outcomes.

Materials and methods

The research question was defined using the PICOST acronym. An exhaustive search, material selection, and data extraction were conducted in duplicate and independently. Original articles were included on patients with metastatic RCC (mRCC) with thrombus in the IVC, treated with immune checkpoint inhibitors with or without tyrosine kinase inhibitors (TKIs) and cytoreductive nephrectomy (CN). Studies involving patients with thrombi localized solely to the renal artery or atrium were excluded.

Results

A total of 17 articles were included: one retrospective cohort, five retrospective case series, and 11 retrospective case reports. In total, 32 patients were analyzed; 10 were excluded due to the absence of metastases. In most cases, the size of the primary tumor decreased. Regarding the thrombus in the IVC, based on the level, out of 22 patients, 7 remained unchanged, 13 showed a reduction (9 by one level, 3 by two levels, and 1 by three levels), and one showed an increase. In another case, the magnitude of the reduction in thrombus size or level was not specified. Tumor thrombus size decreased even in cases where the level remained unchanged.

Conclusions

Patients with mRCC and thrombus in the IVC may benefit from neoadjuvant treatment with immune checkpoint inhibitors, with or without TKIs, and delayed cytoreductive nephrectomy.
用免疫辅助疗法治疗的转移性肾细胞癌和腔静脉肿瘤血栓的成人延迟细胞还原肾切除术:系统综述
肾细胞癌(RCC)侵袭下腔静脉(IVC)的病例占4%至10%,增加了影响肿瘤预后的手术并发症的风险。材料与方法本研究问题采用PICOST首字母缩略词进行定义。详尽的搜索,材料选择和数据提取进行了两份和独立。原始文章纳入了在IVC中有血栓的转移性肾癌(mRCC)患者,接受免疫检查点抑制剂联合或不联合酪氨酸激酶抑制剂(TKIs)和细胞减减性肾切除术(CN)治疗。排除了血栓仅局限于肾动脉或心房的患者。结果共纳入17篇文章:1篇回顾性队列,5篇回顾性病例系列,11篇回顾性病例报告。共分析32例患者;10例因无转移而被排除。在大多数病例中,原发肿瘤的大小减小。对于下腔静脉血栓,22例患者中,7例保持不变,13例减少(9例减少一级,3例减少二级,1例减少三级),1例增加。在另一种情况下,血栓大小或水平减少的幅度没有指定。即使在水平保持不变的情况下,肿瘤血栓的大小也会减小。结论mRCC和IVC血栓患者可能受益于免疫检查点抑制剂的新辅助治疗,联合或不联合TKIs,以及延迟的细胞减减性肾切除术。
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来源期刊
Actas urologicas espanolas
Actas urologicas espanolas UROLOGY & NEPHROLOGY-
CiteScore
1.90
自引率
0.00%
发文量
98
审稿时长
46 days
期刊介绍: Actas Urológicas Españolas is an international journal dedicated to urological diseases and renal transplant. It has been the official publication of the Spanish Urology Association since 1974 and of the American Urology Confederation since 2008. Its articles cover all aspects related to urology. Actas Urológicas Españolas, governed by the peer review system (double blinded), is published online in Spanish and English. Consequently, manuscripts may be sent in Spanish or English and bidirectional free cost translation will be provided.
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