骨转移影响转移性肾细胞癌患者的预后，但不影响三线靶向治疗的疗效。
Bone metastases affect prognosis but not effectiveness of third-line targeted therapies in patients with metastatic renal cell carcinoma.
作者信息
Iacovelli Roberto, Santini Daniele, Rizzo Mimma, Felici Alessandra, Santoni Matteo, Verzoni Elena, Masini Cristina, Massari Francesco, Calvani Nicola, Mosca Alessandra, Procopio Giuseppe
机构信息
Department of Radiology, Oncology and Human Pathology, Sapienza University of Rome, Rome, Italy;
Fondazione IRCCS Istituto Nazionale Tumori, Division of Medical Oncology, Rome, Italy.
出版信息
Can Urol Assoc J. 2015 Jul-Aug;9(7-8):263-7. doi: 10.5489/cuaj.2377.
INTRODUCTION
Treatment of metastatic renal cell carcinoma (mRCC) has improved with the use of targeted therapies, but bone metastases continue to be negative prognostic factor.
METHODS
Patients with mRCC treated with everolimus (EV) or sorafenib (SO) after two previous lines of targeted therapies were included in the analysis. Overall survival (OS) and progression-free survival (PFS) were assessed based on the presence of bone metastases and type of therapy; they were also adjusted based on prognostic criteria.
RESULTS
Of the 233 patients with mRCC, 76 had bone metastases. Of the 233 patients, EV and SO were administered in 143 and 90 patients, respectively. Median OS was 10.4 months in patients with BMs and 17.4 months in patients without bone metastases (p = 0.002). EV decreased the risk of death by 18% compared to SO (adjusted hazard ratio [HR] 0.82, 95% confidence interval [CI] 0.74-0.91; p < 0.001), with comparable effects in patients with or without bone metastases. In the same manner, EV decreased the risk of progression by 12% compared to SO (adjusted HR 0.88, 95% CI 0.82-0.96; p = 0.002), but this difference was not significant in patients without bone metastases. The major limitations of the study are its retrospective nature, the heterogeneity of the methods to detect bone metastases, and the lack of data about patients treated with bisphosphonates.
CONCLUSIONS
The relative benefit of targeted therapies in mRCC is not affected by the presence of bone metastases, but patients without bone metastases have longer response to therapy and overall survival.
引言
随着靶向治疗的应用，转移性肾细胞癌（mRCC）的治疗有了改善，但骨转移仍然是不良预后因素。
方法
分析在接受过两线靶向治疗后接受依维莫司（EV）或索拉非尼（SO）治疗的mRCC患者。根据是否存在骨转移和治疗类型评估总生存期（OS）和无进展生存期（PFS）；还根据预后标准进行了调整。
结果
在233例mRCC患者中，76例有骨转移。在这233例患者中，分别有143例和90例接受了EV和SO治疗。有骨转移患者的中位OS为10.4个月，无骨转移患者为17.4个月（p = 0.002）。与SO相比，EV使死亡风险降低了18%（调整后风险比[HR] 0.82，95%置信区间[CI] 0.74 - 0.91；p < 0.001），在有或无骨转移的患者中效果相当。同样，与SO相比，EV使进展风险降低了12%（调整后HR 0.88，95% CI 0.82 - 0.96；p = 0.002），但在无骨转移的患者中这种差异不显著。该研究的主要局限性在于其回顾性性质、检测骨转移方法的异质性以及缺乏关于接受双膦酸盐治疗患者的数据。
结论
靶向治疗在mRCC中的相对获益不受骨转移的影响，但无骨转移的患者对治疗的反应和总生存期更长。
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