Zhao Juping, Huang Xin, Sun Fukang, Ma Renyi, Wang Haofei, Shao Kun, Zhu Yu, Zhou Wenlong, Xu Zhaoping, Shen Zhoujun
Department of Urology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200025, China;
Department of Pathology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200025, China.
Can Urol Assoc J. 2014 Nov;8(11-12):E821-7. doi: 10.5489/cuaj.2096.
We wanted to identify the prognostic factors for overall survival (OS) in Chinese patients with metastatic renal cell carcinoma (mRCC) treated with first-line targeted therapy (sorafenib or sunitinib).
We retrospectively reviewed clinical data from 119 mRCC patients administered sorafenib or sunitinib at the Ruijin Hospital since 2007. OS rates were calculated by the Kaplan-Meier method. Each variable was investigated univariately and then multivariately using a stepwise algorithm. A multivariate Cox regression model analyzed baseline variables for prognostic significance.
The mean patient age was 57 ± 12 years; 37 patients (31%) received sorafenib and 82 (69%) received sunitinib. The mean OS was 22.7 ± 15.6 months (range: 2.8- 68.7). OS rates at year 1, 3 and 5 were 74%, 57%, and 36%, respectively. Univariate analysis identified significant negative prognostic factors (p < 0.05) as Eastern Cooperative Oncology Group (ECOG) performance status ≥2, symptoms, no prior nephrectomy, microscopic necrosis, ≥2 metastatic sites, presence of liver, bone, or pancreas metastasis, hemoglobin less than the lower limit of normal(female <115 g/L, male <130 g/L), and serum alkaline phosphatase greater than the upper limit of normal (126 IU/L) at baseline, as well as a relative dose intensity of targeting agents in the first month (1M-RDI) of <50%. Multivariate analysis of OS identified 4 independent predictors: no symptoms, no bone or pancreas metastasis, and 1M-RDI of targeting agents (≥50%).
With targeted therapy, there is some change in the prognostic factors for mRCC and target drug therapies (1M-RDI ≥50%) play an important role in the prognosis of mRCC. Continued progress in the identification of patient-specific prognostic factors for mRCC will require further advances in the understanding of tumour biology.
我们希望确定接受一线靶向治疗（索拉非尼或舒尼替尼）的中国转移性肾细胞癌（mRCC）患者总生存期（OS）的预后因素。
我们回顾性分析了自2007年以来在瑞金医院接受索拉非尼或舒尼替尼治疗的119例mRCC患者的临床资料。采用Kaplan-Meier法计算总生存率。对每个变量进行单因素分析，然后使用逐步算法进行多因素分析。多变量Cox回归模型分析基线变量的预后意义。
患者平均年龄为57±12岁；37例患者（31%）接受索拉非尼治疗，82例（69%）接受舒尼替尼治疗。平均总生存期为22.7±15.6个月（范围：2.8 - 68.7个月）。1年、3年和5年的总生存率分别为74%、57%和36%。单因素分析确定的显著不良预后因素（p < 0.05）为东部肿瘤协作组（ECOG）体能状态≥2、有症状、未行肾切除术、镜下坏死、转移部位≥2个、存在肝、骨或胰腺转移、基线时血红蛋白低于正常下限（女性<115 g/L，男性<130 g/L）、血清碱性磷酸酶高于正常上限（126 IU/L），以及靶向药物在第一个月的相对剂量强度（1M-RDI）<50%。总生存期的多因素分析确定了4个独立预测因素：无症状、无骨或胰腺转移以及靶向药物的1M-RDI（≥50%）。
在靶向治疗中，mRCC的预后因素有一些变化，靶向药物治疗（1M-RDI≥50%）在mRCC的预后中起重要作用。要在确定mRCC患者特异性预后因素方面持续取得进展，需要在肿瘤生物学理解上取得进一步进展。
