Clinical and pathological characteristics of patients with renal cell carcinoma treated with sunitinib

Karcinom bubrega je zloćudni tumor porijekla epitela bubrežnih kanalića, a najčešći histološki tip je tzv. svijetlostanični karcinom bubrega. Kirurško liječenje je metoda izbora za rane stadije karcinoma bubrega, dok je u slučaju metastatske bolesti neophodno i sistemno liječenje. U ovome radu prikazane su kliničke i patološke karakteristike bolesnika s metastatskim karcinomom bubrega liječenim antiangiogenim terapeutikom-sunitinibom u KBC Zagreb u vremenskom razdoblju od 6 godina (1. 7. 2010 - 30. 6. 2016.) Za 85 bolesnika liječenih sunitinibom bili su dostupni relevantni klinički i patološki podaci. Radilo se o 62 muškaraca i 23 žene (omjer 2,7:1), dobi od 33 do 80 godina (medijan 59 godina). Svijetlostanični karcinom bubrega je dijagnosticiran u 96,5% slučajeva, a ostatak čine neklasificirani karcinomi sa sarkomatoidnom slikom. Veličina primarnih tumora kretala se od 4 do 13 cm; prosječno 7,9 cm. Primarno metastatski karcinom bubrega je dijagnosticiran u 47 (55,3%) analiziranih bolesnika, dok su u ostalih metastaze nađene u razdoblju od 1 do čak 19 godina od dijagnoze primarnog karcinoma bubrega. Najčešća metastatska sijela bila su pluća (77,6%), kosti (56,4%) i jetra (22,3%). U analiziranoj skupini, liječenje sunitinibom je trajalo od nekoliko mjeseci do 8 godina, a u 62 (73%) bolesnika je sunitinib naknadno zamijenjen drugim lijekom, najčešće sorafenibom (18 bolesnika), nivolumabom (15 bolesnika) te everolimusom (13 bolesnika). U razdoblju praćenja 55 (64,7%) bolesnika je preminulo; 19 (22,4%) je živo s metastatskom bolešću, a 11 (12,9%) je izgubljeno iz praćenja. Petogodišnje preživljenje od dijagnoze karcinoma bubrega izračunato za 72 bolesnika iznosilo je 38,9%. Preživljenje bolesnika s primarno metastatskim karcinomom bubrega je bilo znatno lošije, s 32 (68,08%) bolesnika preminula u prve dvije godine od postavljanja dijagnoze. Od 19 i danas živih bolesnika ispitivane skupine, 9 je na terapiji sunitinibom (trajanje terapije od 3-8 godina); 6 bolesnika prima nivolumab, 3 aksitinib i 1 bolesnik prima pazopanib. Sunitinib je pokazao najveću učinkovitost u slučajevima oligometastatske bolesti te u slučajevima plućnih metastaza. Sunitinib i ostali terapeutici nisu pokazali značajnu učinkovitost kod pacijenata s prisutnim višestrukim metastatskim sijelima u sklopu brzo napredujuće bolesti te u slučaju moždanih metastaza.Renal cell carcinoma (RCC) is malignant tumor originating from epithelial lining of renal tubules. The most common type is clear cell renal cell carcinoma. Surgical approach is treatment of choice for early stage of RCC, while systemic therapy is needed for more advanced cases. This study included patients with advanced RCC treated with sunitinib at University Hospital Centre Zagreb between July 2010 and June 2016. Main clinical and pathological features were analyzed. Of 91 patients, relevant clinical and pathological data were available for 85 patients; 62 males and 23 females (ratio 2,7:1), with age range 33-80 years (median 59 years). Clear cell RCC was diagnosed in 96,5% and sarcomatoid unclassified RCC in rest of the cases. Size of primary tumors varied from 4 to 13 cm (average 7,9 cm). Primary metastatic RCC was diagnosed in 47 (55,3%) cases, in other metastases occurred in period from less than 1 year to up to 19 years after primary RCC. The most common metastatic sites were lungs (77,6%), bones (56,4%) and liver (22,3%). Sunitinib as a treatment for advanced RCC was used in wide period range, from few months to up to 8 years. During treatment and follow-up of 62 patients, sunitinib has been replaced with other therapeutics, most commonly with sorafenib (18 patients), nivolumab (15 patients) or everolimus (13 patients). In follow-up period 55 (64,7%) of patients included in this study died; 19 (22,4%) are alive with metastatic disease and 11 (12,9%) were lost from follow-up. Overall 5-year survival available for 72 analyzed patients was 38,9%. Patients with primary metastatic RCC had worse prognosis; 32 (68,08%) died in the first 2 years after diagnosis. Of 19 still alive patients, 9 are treated with sunitinib (duration of therapy 3-8 years); 6 with nivolumab, 3 with axitinib and one with pazopanib. Sunitinib showed the best efficacy in cases of oligometastatic disease and lung metastases. Sunitinib and other mentioned therapeutics were less efficient in cases with high tumor volume, multiple metastatic sites, highly advanced metastatic disease and brain metastases