外科在轉(zhuǎn)移性腎癌靶向治療時(shí)代的地位38張課件

外科在轉(zhuǎn)移性腎癌靶向治療時(shí)代的地位外科在轉(zhuǎn)移性腎癌靶向治療時(shí)代的地位外科在轉(zhuǎn)移性腎癌靶向治療時(shí)代的地位轉(zhuǎn)移性腎癌(mRCC)的治療MetastaticrenalcellcarcinomaCytoreductiveCytoreductivePresurgicaltargetednephrectomynephrectomytherapyfollowedfollowedbyandcompletebycytoreductivetherapyalonetargetedtherapymetastasectomynephrectomy減瘤性腎切除(CN)支持反對(duì)緩解癥狀(疼痛手術(shù)是有創(chuàng)治療出血,副瘤綜合癥)·改善一般狀況術(shù)后需要恢復(fù)時(shí)間延緩了系統(tǒng)治療使·原發(fā)腫瘤對(duì)系統(tǒng)治療的療效欠佳用時(shí)間改善系統(tǒng)治療的療部分患者,在術(shù)后效恢復(fù)期可能出現(xiàn)病改善生存率情的進(jìn)展,轉(zhuǎn)移灶自發(fā)緩解外科在轉(zhuǎn)移性腎癌靶向治療時(shí)代的地位外科在轉(zhuǎn)移性腎癌靶向治療時(shí)轉(zhuǎn)移性腎癌(mRCC)的治療MetastaticrenalcellcarcinomaCytoreductiveCytoreductivePresurgicaltargetednephrectomynephrectomytherapyfollowedfollowedbyandcompletebycytoreductivetherapyalonetargetedtherapymetastasectomynephrectomy轉(zhuǎn)移性腎癌(mRCC)的治療減瘤性腎切除(CN)支持反對(duì)緩解癥狀(疼痛手術(shù)是有創(chuàng)治療出血,副瘤綜合癥)·改善一般狀況術(shù)后需要恢復(fù)時(shí)間延緩了系統(tǒng)治療使·原發(fā)腫瘤對(duì)系統(tǒng)治療的療效欠佳用時(shí)間改善系統(tǒng)治療的療部分患者,在術(shù)后效恢復(fù)期可能出現(xiàn)病改善生存率情的進(jìn)展,轉(zhuǎn)移灶自發(fā)緩解減瘤性腎切除(CN)細(xì)胞因子時(shí)代:CN能改善mRCC的預(yù)后SWOG89491991-1998246patients(80institutions)NephrectomyplusinterferonBiopsy-provenRCC·SWOGPS0-1·OverallSurvivalSurgery+IFNa>11.1monthsenteronaloneFNaalone→81monthsFlaniganRNEJM.2001細(xì)胞因子時(shí)代:CN能改善mRCC的預(yù)后細(xì)胞因子時(shí)代:CN能改善mRCC的預(yù)后EORTC309478100·1995-1998·ControlgroupLogrankp=0-03patientsBiopsy-provenRCC·WHOPS0-1Time(years)Overal」urvivalObservednumberlumberofpatientsatriskSurgery+IFNa17monthsControls304FNaalone→7monthsMickischgh.lancet.2001細(xì)胞因子時(shí)代:CN能改善mRCC的預(yù)后細(xì)胞因子時(shí)代:CN能改善mRCC的預(yù)后CombinedResults(SW0G8949+EORTC30947)OverallSurvivalNephrectomyIFNa)13.6months·|ENaalone+7.8monthsLagalTestp-0001ONFlaniganRC.JUrol.2004細(xì)胞因子時(shí)代:CN能改善mRCC的預(yù)后靶向治療能延長mRCC患者的生存DrugPatientsRandomizationgoingPrimaryendandresultsSunitinibSunitinibysinterfcron-cxProgression-freesurvivalllmowithsunitinib5mowithinterferon-a(P<0.001)gherobjectiveresponBetterqualityoflifecomparedtointerferon-cSorafenib[10Sorafenibvsplaceboogiession-frcesurvival5thsorafenibvsithplacebo(P<0.o1)mprovedoverallsurvivalPazopanibPazopanibvsplaceboogression-freesurvival9.2mowithpazopanibmowithplacebo(P<0.000ImprovedobjectiveresponserateBevacizumab[873BevacizumabplusOverallsurvival18.3mowithbevacizumabphsnterferon-avs17.4mowithinterferon-a(P-0.097)Improvedprogression-freesurvivalBevacizumab19649BevacizumabplusDverallsurvival23.3mowithbevacizumabphisinterferon-avsnterferon-avs21.3mowithinterferon-a(P-0,336)Improvedprogression-freesurvivalcombinedtherapywithinterferon-ay8withcambinedtherapyP=0.008)靶向治療能延長mRCC患者的生存靶向治療時(shí)代轉(zhuǎn)移性腎癌是否應(yīng)行減瘤性腎切除術(shù)靶向治療時(shí)代轉(zhuǎn)移性腎癌是否應(yīng)行CARMENAtrial:Phase3RandomizedStudyComparingNephrectomyplusSunitinibversusSunitinibwithoutNephrectomyin1stlinemetastaticRCCSunitinib50meRandomizationNephrectomyN=576Sunitinib50mgPl:Dr.arnaudMejeanPrimaryEndpoint:OverallSurvivalStartDate:September2009Estimatedcompletiondate:February2020ClinicalTIdentifier:NCTo0930033CARMENAtrial:Phase3RandomiSURTIMEtrial:ImmediateSurgeryorSurgeryAfterSunitinibMalateinTreatingPatientsWithMetastaticKidneyCancerRandomizationNephrectomySunitinibN=458SunitinibNephrectomyHSunitinibPl:Dr.axelbexPrimaryEndpoint:Progression-FreeSurvivalStartDate:April2010StoppedAccrual:April2016ClinicalTIdentifier:NCTO1099423SURTIMEtrial:ImmediateSurge外科在轉(zhuǎn)移性腎癌靶向治療時(shí)代的地位38張課件外科在轉(zhuǎn)移性腎癌靶向治療時(shí)代的地位38張課件外科在轉(zhuǎn)移性腎癌靶向治療時(shí)代的地位38張課件外科在轉(zhuǎn)移性腎癌靶向治療時(shí)代的地位38張課件外科在轉(zhuǎn)移性腎癌靶向治療時(shí)代的地位38張課件外科在轉(zhuǎn)移性腎癌靶向治療時(shí)代的地位38張課件外科在轉(zhuǎn)移性腎癌靶向治療時(shí)代的地位38張課件外科在轉(zhuǎn)移性腎癌靶向治療時(shí)代的地位38張課件外科在轉(zhuǎn)移性腎癌靶向治療時(shí)代的地位38張課件外科在轉(zhuǎn)移性腎癌靶向治療時(shí)代的地位38張課件外科在轉(zhuǎn)移性腎癌靶向治療時(shí)代的地位38張課件外科在轉(zhuǎn)移性腎癌靶向治療時(shí)代的地位38張課件外科在轉(zhuǎn)移性腎癌靶向治療時(shí)代的地位38張課件外科在轉(zhuǎn)移性腎癌靶向治療時(shí)代的地位38張課件外科在轉(zhuǎn)移性腎癌靶向治療時(shí)代的地位38張課件外科在轉(zhuǎn)移性腎癌靶向治療時(shí)代的地位38張課件外科在轉(zhuǎn)移性腎癌靶向治療時(shí)代的地位38張課件外科在轉(zhuǎn)移性腎癌靶向治療時(shí)代的地位38張課件外科在轉(zhuǎn)移性腎癌靶向治療時(shí)代的地位38張課件外科在轉(zhuǎn)移性