Berrak Hücreli Böbrek Hücreli Karsinomlarda Tirozin Kinaz İnhibitörleri Sonrası İmmünoterapide Ön Sitoredüktif Cerrahinin Etkisi

Öz

Amaç: Bu çalışmanın amacı, metastatik berrak hücreli renal karsinom (mRHK) tanısı almış ve birinci basamakta tirozin kinaz inhibitörü (TKİ), ikinci basamakta immünoterapi (nivolumab) ile tedavi edilen hastalarda ilk basamakta yapılan sitoredüktif nefrektominin sağkalım sonuçla- rı üzerindeki etkisini araştırmaktır. Gereç ve Yöntemler: Bu retrospektif, tek merkezli çalışmada 2010–2023 yılları arasında tedavi edilen 38 hasta incelendi. Tüm hastalara birinci basamakta sunitinib, ikinci basamakta nivolumab uygulandı. Hastalar ilk basamakta tümör rezeksiyonu yapılanlar (PTR grubu) ve yapılmayanlar (non-PTR grubu) olarak ikiye ayrıldı. Progresyonsuz sağkalım (PFS1, PFS2) ve genel sağkalım (OS) analizleri Kaplan-Meier yöntemiyle değerlendirildi. Bulgular: PTR grubunda objektif yanıt oranı %79 iken no-PTR grubunda %22 idi (p=0,003). Medyan PFS1 PTR grubunda 16,7 ay, no-PTR grubunda 7,1 ay olarak saptandı (p=0,006). Medyan PFS2 PTR grubunda henüz ulaşılmamışken, non-PTR grubunda 54,1 ay idi (p=0,290). PTR grubunda OS daha uzun olmakla birlikte istatistiksel anlamlılık göstermedi (p=0,108). Sonuç: TKİ sonrası nivolumab alan mHRK hastalarında ilk basamakta sitoredüktif nefrektomi, yanıt oranını artırmakta ve progresyonsuz sağkalımı uzatmaktadır. Ancak genel sağkalım üzerindeki etkisi istatistiksel olarak anlamlı bulunmamıştır. Prospektif ve geniş ölçekli çalışmalarla bu sonuçların doğrulanması gereklidir.

Anahtar Kelimeler

• renal hücreli karsinom
• sitoredüktif nefrektomi
• immünoterapi
• tirozin kinaz inhibitörü
• sağkalım

The Benefit of Upfront Cytoreductive Surgery on the Effect of Immunotherapy After Tyrosine Kinase Inhibitor Therapies in Clear Cell Renal Cell Carcinomas

Öz

Aim: This study aimed to evaluate the effect of upfront cytoreductive nephrectomy on survival outcomes in patients with metastatic clear cell renal cell carcinoma (RCC) who received tyrosine kinase inhibitor (TKI) therapy followed by immunotherapy (nivolumab). Materials and Methods: This retrospective, single-center study included 38 patients treated between 2010 and 2023. All patients received sunitinib as first-line and nivolumab as second-line therapy. The patients were divided into two groups based on whether they underwent primary tumor resection (PTR group) or not (non-PTR group). Progression-free survival (PFS1, PFS2) and overall survival (OS) were assessed by Kaplan-Meier analysis. Results: The objective response rate was 79% in the PTR group and 22% in the non-PTR group (p=0.003). The median PFS1 was 16.7 months in the PTR group and 7.1 months in the non-PTR group (p=0.006). Median PFS2 was not reached in the PTR group, whereas it was 54.1 months in the non-PTR group (p=0.290). Although the OS was longer in the PTR group, the difference was not statistically significant (p=0.108). Conclusion: Upfront cytoreductive nephrectomy appears to improve response rates and progression-free survival in patients with metastatic RCC receiving sequential TKI and nivolumab therapy. However, this effect on overall survival was not statistically significant. These findings warrant validation through prospective, large-scale studies.

Anahtar Kelimeler

• renal cell carcinoma
• cytoreductive nephrectomy
• immunotherapy
• tyrosine kinase inhibitor
• survival

Kaynakça

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