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目的:评价索拉非尼治疗进展性肾癌的疗效,分析患者长期存活的因素。方法:选择晚期转移性肾癌患者19例,年龄39~73岁,中位年龄51岁。组织学分型以透明细胞癌或透明细胞癌为主16例(84.2%),嫌色细胞癌1例,乳头状细胞癌2例。采用索拉非尼400mg,每天2次口服,直至肿瘤再次进展或出现不可耐受的不良反应时止。结果:治疗后的生存时间已超过5年者19例,可评价疗效,占同期患者的28.4%(19/67)。平均随访时间5.8年,按RECIST标准评价疗效:部分缓解(PR)8例,其中肺部病灶6例,肾脏病灶1例;完全缓解(CR)1例,为肺部病灶;疾病稳定(SD)7例,疾病进展(PD)3例;总缓解率为13.4%(9/67),疾病控制率为23.8%(16/67)。发生频率较高的不良反应分别为手足皮肤反应16例(16/19,84.2%),脱发15例(78.9%),血压升高14例(73.7%),疲乏14例(73.7%),食欲下降13例(68.4%),牙龈肿痛11例(57.8%),腹泻10例(52.6%),皮疹9例(47.4%),口腔黏膜炎9例(47.4%),贫血5例(26.3%)。转氨酶升高4例(21.1%)。索拉非尼完全失效后,采用舒尼替尼治疗1例,PD;采用依维莫司治疗1例,SD。中位无进展时间为31.4个月。结论:索拉非尼治疗转移性肾癌患者耐受性良好,疗效显著,不良反应多为轻中度,长期生存的患者相关预后因素仍需进一步观察。
Objective: To evaluate the efficacy of sorafenib in the treatment of advanced renal cell carcinoma and to analyze the long-term survival of patients. Methods: Nineteen patients with advanced metastatic renal cell carcinoma were selected, ranging in age from 39 to 73 years with a median age of 51 years. Histological type of clear cell or clear cell carcinoma in 16 cases (84.2%), 1 case of chromophobe, papillary carcinoma in 2 cases. Sorafenib 400mg, 2 times daily oral until the tumor progress again or intolerable side effects only. Results: 19 cases survived more than 5 years after treatment, and the curative effect was evaluated, accounting for 28.4% (19/67) of patients in the same period. The average follow-up time of 5.8 years was evaluated according to RECIST criteria: partial response (PR) in 8 cases, including 6 cases of lung lesions and 1 case of renal lesions; 1 case of complete remission (CR) 7 cases and 3 cases of disease progression (PD). The overall response rate was 13.4% (9/67) and the disease control rate was 23.8% (16/67). The frequency of adverse reactions were 16 cases (16/19, 84.2%) of hand-foot skin reaction, 15 cases (78.9%) of alopecia, 14 cases (73.7%) of hypertension, 14 cases of fatigue (73.7% There were 11 cases (57.8%) with gingival swelling, 10 cases (52.6%) with diarrhea, 9 cases with rash (47.4%), 9 cases with oral mucositis (47.4%) and 5 cases with anemia (26.3% ). Elevated aminotransferase in 4 cases (21.1%). Sorafenib complete failure, the use of sunitinib treatment of 1 case, PD; with everolimus treatment in 1 case, SD. The median progression-free time was 31.4 months. Conclusion: Sorafenib in patients with metastatic renal cell carcinoma is well tolerated, the effect is significant, the side effects are mostly mild to moderate, and prognostic factors of long-term survival still need further observation.