Toyoda Yutaka, Shinohara Nobuo, Harabayashi Toru, Abe Takashige, Akino Tomoshige, Sazawa Ataru, Nonomura Katsuya
Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Eur Urol. 2007 Jul;52(1):163-8. doi: 10.1016/j.eururo.2006.10.060. Epub 2006 Nov 7.
We retrospectively analyzed the survival of renal cell carcinoma patients with bone metastases, and identified prognostic factors and a model predictive for survival in these patients.
Fifty patients with renal cell carcinoma with osseous metastases were treated at Hokkaido University Hospital between 1980 and 2004. The relationship between several clinical features and survival was examined univariately. The Cox proportional hazards model was then used to form a multivariate model.
The median survival time from the diagnosis of bone metastasis was 12 mo, and overall survival at 2 yr was 37%. Clinical features correlated with longer survival in the multivariate analysis were a long interval (24 mo or more) between the diagnosis of kidney cancer and that of osseous metastasis (hazard ratio [HR]: 2.608; 95% confidence interval [CI], 1.031-6.599) and the absence of extraosseous metastases (HR: 2.523; 95%CI, 1.023-6.220). By combining these two favorable factors, renal cell carcinoma patients with osseous metastases could be categorized into two different groups. The median time to death in 20 patients with zero favorable factors (poor prognosis) was 5 mo. On the other hand, 30 patients had one or two favorable factors (good prognosis); the median survival time in this group was 30 mo. There was a significant difference in survival duration between the two groups (p<0.001).
Two prognostic factors predicting survival were identified and used to categorize renal cell carcinoma patients with bone metastasis into two prognostic groups.
我们回顾性分析了肾细胞癌骨转移患者的生存情况，确定了这些患者的预后因素和生存预测模型。
1980年至2004年间，北海道大学医院治疗了50例肾细胞癌骨转移患者。对几个临床特征与生存之间的关系进行了单因素分析。然后使用Cox比例风险模型构建多变量模型。
从骨转移诊断开始的中位生存时间为12个月，2年总生存率为37%。多变量分析中与较长生存相关的临床特征是肾癌诊断与骨转移诊断之间的间隔时间长（24个月或更长）（风险比[HR]：2.608；95%置信区间[CI]，1.031 - 6.599）以及无骨外转移（HR：2.523；95%CI，1.023 - 6.220）。通过结合这两个有利因素，肾细胞癌骨转移患者可分为两个不同的组。20例无有利因素（预后差）患者的中位死亡时间为5个月。另一方面，30例患者有一个或两个有利因素（预后好）；该组的中位生存时间为30个月。两组之间的生存时间存在显著差异（p<0.001）。
确定了两个预测生存的预后因素，并用于将肾细胞癌骨转移患者分为两个预后组。
