舒尼替尼治疗的透明细胞肾细胞癌患者中骨转移对预后的负面影响。
Negative impact of bone metastasis on outcome in clear-cell renal cell carcinoma treated with sunitinib.
机构信息
Department of Medical Oncology, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, Paris; Inserm U674 Génômique Fonctionnelle des Tumeurs Solides, René Descartes Paris V University, Paris, France.
Department of Medical Oncology, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, Paris; Inserm U674 Génômique Fonctionnelle des Tumeurs Solides, René Descartes Paris V University, Paris, France.
出版信息
Ann Oncol. 2011 Apr;22(4):794-800. doi: 10.1093/annonc/mdq554. Epub 2010 Oct 11.
BACKGROUND
The aim of our study was to determine whether the presence of bone metastases affects outcomes in patients with metastatic clear-cell renal cell carcinoma (m-ccRCC) receiving sunitinib.
PATIENTS AND METHODS
We reviewed the charts of all patients in four academic centers in Belgium and France who started first-line sunitinib (50 mg/day; 4 weeks on and 2 weeks off) between January 2005 and December 2008. Data were collected on known prognostic factors for metastatic renal cell carcinoma and metastatic sites. Response and progression were evaluated by computed tomography scan (according to RECIST).
RESULTS
Two hundred twenty-three patients were identified. With a median follow-up of 40 months, median progression-free survival (PFS) and median overall survival (OS) were significantly shorter in patients with bone metastases than in those without: respectively, 8.2 versus 19.1 months (P<0.0001) and 19.5 versus 38.5 months (P<0.0001). On multivariate analysis, taking on account platelet count, Eastern Cooperative Oncology Group performance status, number of metastatic sites, neutrophil count, corrected serum calcium, time from diagnosis to systemic treatment, and the presence of bone metastases, bone metastasis was the independent variable most significantly associated with poor PFS (P<0.0001) and OS (P=0.001).
CONCLUSION
The presence of bone metastases in m-ccRCC patients has a significant and clinically relevant negative impact on outcome on sunitinib.
背景
我们的研究旨在确定转移性透明细胞肾细胞癌（m-ccRCC）患者中骨转移的存在是否会影响接受舒尼替尼治疗的患者的结局。
患者和方法
我们回顾了 2005 年 1 月至 2008 年 12 月期间在比利时和法国的四个学术中心开始一线舒尼替尼（50mg/天；4 周给药，2 周停药）的所有患者的病历。收集了已知的转移性肾细胞癌和转移部位的预后因素的数据。通过计算机断层扫描（根据 RECIST）评估反应和进展。
结果
共确定了 223 名患者。中位随访 40 个月，骨转移患者的中位无进展生存期（PFS）和中位总生存期（OS）明显短于无骨转移患者：分别为 8.2 个月与 19.1 个月（P<0.0001）和 19.5 个月与 38.5 个月（P<0.0001）。多变量分析考虑血小板计数、东部合作肿瘤组表现状态、转移部位数量、中性粒细胞计数、校正血清钙、从诊断到系统治疗的时间以及骨转移的存在，骨转移是与较差的 PFS（P<0.0001）和 OS（P=0.001）最显著相关的独立变量。
结论
m-ccRCC 患者中骨转移的存在对舒尼替尼治疗的结局有显著的、临床相关的负面影响。
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