Spontaneous Regression Of Multiple Pulmonary Metastases Accompanied By Normalization Of Serum Immune Markers Following Cytoreductive Nephrectomy In A Patient With Clear-cell Renal Cell Carcinoma
Okazaki, A., Kijima, T., Schiller, P., Ishikawa, N., Fuchizawa, H., Takei, K., Suzuki, I., Sakamoto, K., Tsuzuki, T., & Kamai, T. (2020). Spontaneous regression of multiple pulmonary metastases accompanied by normalization of serum immune markers following cytoreductive nephrectomy in a patient with clear-cell renal cell carcinoma. IJU case reports, 4(2), 95–99. https://doi.org/10.1002/iju5.12252
View Original Source →Abstract
INTRODUCTION: The spontaneous regression of metastases, which mostly occurs after surgical resection of the primary tumor, has been described in various malignancies, including renal cell carcinoma. The involvement of the host immune system is currently postulated as the underlying mechanism. CASE PRESENTATION: We present a case of metastatic clear-cell renal cell carcinoma that achieved complete spontaneous regression of multiple pulmonary metastases preceded by normalization of serum immune markers after cytoreductive nephrectomy. The patient remained disease free for 3 years without any systemic therapy, suggesting that postoperative normalization of serum immune markers may indicate recovery of the host immune system, which prevents tumor recurrence. CONCLUSION: Monitoring of serum immune markers may be useful to identify patients with recovered immune function and, therefore, may not require systemic therapy. Similarly, the case suggests a potential role of cytoreductive nephrectomy in the contemporary management of metastatic renal cell carcinoma.
Case Details
Disease Location
Lung
Personal Characteristics
57-year-old woman
Clinical Characteristics
Admitted with symptoms of pyrexia, dry cough, and a weight loss of 5 kg over the last 2 months. CT revealed a left renal tumor, and the patient was referred to our hospital for further investigation and treatment. Contrast-enhanced CT confirmed the left renal tumor (70 mm in diameter) with a tumor thrombus extending into the inferior vena cava. Similarly, contrast-enhanced CT revealed the presence of multiple pulmonary metastases. Laboratory tests revealed anemia, high neutrophil, and platelet count. Elevation in the sil-2r, and a marked elevation in the serum crp level. Two weeks after diagnosis, the patient underwent cytoreductive nephrectomy (cn) with thrombectomy at the left renal vein and vena cava. Pathological diagnosis showed clear-cell rcc,
Remission Characteristics
The patient’s overall well-being improved after cn, and the serum crp and sil-2r levels after 1 week of surgery decreased to 50% of the presurgical level. The serum crp and sil-2r levels continued to decrease and reached a normal level at 3 months after cn. In addition, anemia and thrombocytosis gradually improved within 6 months. Follow-up CT scans revealed spontaneously shrinking pulmonary lesions that ultimately disappeared
Treatment & Mechanisms
Proposed Remission Mechanisms
Primary tumor was recognized and targeted by the host immune system.
Clinical Treatment
Biopsy