Shvarts Oleg, Lam John S, Kim Hyung L, Han Ken-ryu, Figlin Robert, Belldegrun Arie
Division of Urologic Oncology, Department of Urology, David Geffen School of Medicine at University of California-Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA 90095-1738, USA.
J Urol. 2004 Sep;172(3):867-70. doi: 10.1097/01.ju.0000135803.91207.b0.
We identified a subset of patients with renal cell carcinoma (RCC) who have a high likelihood of presenting with bone metastasis and would most benefit from a preoperative bone scan.
A database of 1,357 patients undergoing nephrectomy and/or immunotherapy for RCC at our institution was queried. Patients presenting with metastasis to the bones were identified and stratified according to T stage, Eastern Cooperative Oncology Group (ECOG) score, musculoskeletal symptoms and alkaline phosphatase.
Of the patients 37% presented with metastasis. Bone metastasis was identified in 14% of patients. The incidence of bone metastasis was 5.4%, 13.8%, 15.4% and 28.2% in patients with T1 to T4 lesions, and 1.4%, 19% and 41% in those with an ECOG score of 0 to 2 and greater, respectively. T stage and ECOG score were then integrated. Bone metastasis was confirmed in 0.046%, 3.8%, 1.4% and 0% of patients with T1 to T4/ECOG 0 disease, and in 13.4%, 20%, 21.5% and 31% of those with T1 to T4/ECOG greater than 0 disease, respectively (p < 0.0001). Only 1.4% of patients with an ECOG score of 0 harbored bone metastasis, of whom 71% complained of musculoskeletal pain, 100% manifested extraosseous metastases and 25% had increased alkaline phosphatase at presentation.
Performance status is an important predictor of bone metastasis in patients presenting with presumed RCC lesions. Bone scan should be performed in patients with an ECOG score of greater than 0 regardless of T stage but is unnecessary in those presenting with an ECOG score of 0, particularly when lacking symptoms and extraosseous metastasis.
我们确定了一部分肾细胞癌（RCC）患者，他们发生骨转移的可能性很高，术前骨扫描对其将最有益处。
查询了我院1357例接受肾切除术和/或免疫治疗的RCC患者的数据库。确定出现骨转移的患者，并根据T分期、东部肿瘤协作组（ECOG）评分、肌肉骨骼症状和碱性磷酸酶进行分层。
37%的患者出现转移。14%的患者被确定有骨转移。T1至T4期病变患者的骨转移发生率分别为5.4%、13.8%、15.4%和28.2%，ECOG评分为0至2分及更高的患者骨转移发生率分别为1.4%、19%和41%。然后将T分期和ECOG评分综合起来。T1至T4期/ECOG 0分疾病患者中骨转移确诊率分别为0.046%、3.8%、1.4%和0%，而T1至T4期/ECOG大于0分疾病患者中骨转移确诊率分别为13.4%、20%、21.5%和31%（p<0.0001）。ECOG评分为0的患者中只有1.4%有骨转移，其中71%主诉有肌肉骨骼疼痛，100%有骨外转移，25%在就诊时碱性磷酸酶升高。
对于疑似患有RCC病变的患者，体能状态是骨转移的重要预测指标。ECOG评分大于0的患者无论T分期如何均应进行骨扫描，但ECOG评分为0的患者则无需进行，尤其是在没有症状和骨外转移的情况下。
