Stadler Walter M, Huo Dezheng, George Christopher, Yang Ximing, Ryan Christopher W, Karrison Theodore, Zimmerman Todd M, Vogelzang Nicholas J
University of Chicago, Illinois 60637, USA.
J Urol. 2003 Oct;170(4 Pt 1):1141-5. doi: 10.1097/01.ju.0000086829.74971.4a.
Combination gemcitabine and 5-fluorouracil (5-FU) may have activity in metastatic renal cell cancer. To identify patient subgroups most likely to benefit and compare survival to that in previously described patient series long-term survival as a function of known and suspected prognostic variables was determined.
The survival status of 153 patients with metastatic renal cell cancer treated on 1 phase I and 4 phase II trials of gemcitabine/5-FU based regimens was updated. Univariate and multivariate Cox proportional hazards models were constructed using multiple imputation for missing values.
Performance status, prior nephrectomy, number of metastatic sites, decreased albumin and elevated alkaline phosphatase were highly prognostic for survival. Sarcomatoid differentiation and hypercalcemia had borderline prognostic significance. Using a previous described prognostic model that divided patients into 3 risk groups survival in those treated with gemcitabine/5-FU in this series was consistently better than survival in similar patients treated in the Motzer series.
Previously described prognostic factors for survival in metastatic renal cancer were confirmed. There is no clearly identifiable group that is most likely to benefit from a gemcitabine/5-FU regimen but there is a continued suggestion that this regimen provides a modest improvement over historical chemotherapy approaches.
吉西他滨与5-氟尿嘧啶（5-FU）联合使用可能对转移性肾细胞癌有活性。为了确定最可能受益的患者亚组，并将生存率与先前描述的患者系列中的生存率进行比较，我们确定了长期生存率作为已知和可疑预后变量的函数。
更新了153例接受基于吉西他滨/5-FU方案的1项I期和4项II期试验治疗的转移性肾细胞癌患者的生存状况。使用多重填补法对缺失值构建单变量和多变量Cox比例风险模型。
体能状态、既往肾切除术、转移部位数量、白蛋白降低和碱性磷酸酶升高对生存具有高度预后价值。肉瘤样分化和高钙血症具有临界预后意义。使用先前描述的将患者分为3个风险组的预后模型，本系列中接受吉西他滨/5-FU治疗的患者的生存率始终优于Motzer系列中类似患者的生存率。
先前描述的转移性肾癌生存预后因素得到证实。没有明确可识别的最可能从吉西他滨/5-FU方案中受益的组，但持续表明该方案比历史化疗方法有适度改善。
