University of Calgary, Tom Baker Cancer Center, Calgary, AB, Canada; University Medicine Greifswald, Department of Urology, Greifswald, Germany.
Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
Eur Urol. 2014 Jun;65(6):1086-92. doi: 10.1016/j.eururo.2013.07.031. Epub 2013 Jul 30.
A subset of primarily localized renal cell carcinoma (RCC) patients will experience disease recurrence ≥5 yr after initial nephrectomy.
To characterize the clinical outcome of patients with late recurrence beyond 5 yr.
DESIGN, SETTING, AND PARTICIPANTS: Patients with metastatic RCC (mRCC) treated with targeted therapy were retrospectively characterized according to time to relapse. Relapse was defined as the diagnosis of recurrent metastatic disease >3 mo after initial curative-intent nephrectomy. Patients with synchronous metastatic disease at presentation were excluded. Patients were classified as early relapsers (ERs) if they recurred within 5 yr; late relapsers (LRs) recurred after 5 yr.
Demographics were compared with the Student t test, the chi-square test, or the Fisher exact test. The survival time was estimated with the Kaplan-Meier method, and associations with survival outcome were assessed with univariable and multivariable Cox regression analyses.
Among 1210 mRCC patients treated with targeted therapy after surgery for localized disease, 897 (74%) relapsed within the first 5 yr and 313 (26%) (range: 5-35 yr) after 5 yr. LRs presented with younger age (p<0.0001), fewer with sarcomatoid features (p<0.0001), more clear cell histology (p=0.001), and lower Fuhrman grade (p<0.0001). Overall objective response rates to targeted therapy were better in LRs versus ERs (31.8% vs 26.5%; p=0.004). LRs had significantly longer progression-free survival (10.7 mo vs 8.5 mo; p=0.005) and overall survival (OS; 34.0 mo vs 27.4 mo; p=0.004). The study is limited by its retrospective design, noncentralized imaging and pathology review, missing information on metastatectomy, and nonstandardized follow-up protocols.
A quarter of patients who eventually developed metastatic disease and were treated with targeted therapy relapsed over 5 yr from initial nephrectomy. LRs have more favorable prognostic features and consequently better treatment response and OS.
一部分主要为局限性肾细胞癌（RCC）患者在初始肾切除术后 5 年以上会经历疾病复发。
描述 5 年以上复发的晚期复发患者的临床结局。
设计、地点和参与者：对接受靶向治疗的转移性 RCC（mRCC）患者根据复发时间进行回顾性特征描述。复发定义为在初始治愈性肾切除术 3 个月后诊断出复发性转移性疾病。排除了在初次就诊时即存在同步转移疾病的患者。如果在 5 年内复发，则将患者归类为早期复发者（ERs）；如果在 5 年后复发，则归类为晚期复发者（LRs）。
采用 Student t 检验、卡方检验或 Fisher 确切概率法比较患者的特征。采用 Kaplan-Meier 方法估计生存时间，采用单变量和多变量 Cox 回归分析评估与生存结果的关联。
在 1210 例接受手术治疗局限性疾病后接受靶向治疗的 mRCC 患者中，897 例（74%）在 5 年内复发，313 例（26%）（范围：5-35 年）在 5 年后复发。LRs 患者的年龄较小（p<0.0001），肉瘤样特征较少（p<0.0001），透明细胞组织学更多（p=0.001），Fuhrman 分级更低（p<0.0001）。LRs 患者的总体客观缓解率优于 ERs（31.8%比 26.5%；p=0.004）。LRs 的无进展生存期（10.7 个月比 8.5 个月；p=0.005）和总生存期（OS；34.0 个月比 27.4 个月；p=0.004）均显著延长。该研究的局限性在于其回顾性设计、非集中化的影像学和病理学审查、缺少关于转移瘤切除术的信息以及非标准化的随访方案。
四分之一最终发生转移疾病并接受靶向治疗的患者在初始肾切除术后 5 年以上复发。LRs 具有更有利的预后特征，因此治疗反应和 OS 更好。
