Eminaga Okyaz, Akbarov Ilgar, Wille Sebastian, Engelmann Udo
Department of Urology, University Hospital of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany.
Int Urol Nephrol. 2015 Oct;47(10):1653-63. doi: 10.1007/s11255-015-1093-y. Epub 2015 Sep 2.
The effect of adjuvant radiation therapy on survival in sarcomatoid renal cell carcinoma (sRCC) with no evidence of distant metastasis remains unclear.
Subjects diagnosed with non-metastatic sRCC were identified using the Surveillance Epidemiology and End Results (SEER) (2004-2012) database and divided into groups based on their surgical treatment (ST): no surgery or radiation therapy (NSR); partial nephrectomy (PNE); radical nephrectomy with ureterectomy and bladder cuff resection (RNE + UE + BLAD); and radical nephrectomy (RNE). Certain radical nephrectomy cases also received adjuvant external-beam radiation therapy (RNE + RAD). The Kaplan-Meier method was used to estimate overall survival (OS). A multivariable competing risks regression analysis was used to calculate disease-specific survival (DSS) probability and to determine factors associated with cause-specific mortality (CSM).
A total of 408 patients were included in this study. The 5-year OS and predicted DSS were significantly higher in the patients who underwent STs (i.e., PNE, RNE + UE + BLAD, RNE, and RNE + RAD) (20.1-54.0 and 20.1-59.9 %, respectively) than in the NSR group (9.0 and 11.6 %, respectively) (P < 0.001). ST was independently associated with a decreased CSM (P < 0.0001). No significant differences in OS or the 1-, 3-, or 5-year DSS probabilities between the RNE and RNE + RAD groups were observed. RNE + RAD was not significantly associated with a decrease in 1-year CSM [subhazard ratio (SHR) 0.95; 95 % CI 0.23-3.96; P = 0.947].
Adjuvant external-beam radiation therapy did not increase OS in non-metastatic sRCC patients.
辅助放疗对无远处转移证据的肉瘤样肾细胞癌（sRCC）患者生存的影响尚不清楚。
利用监测、流行病学和最终结果（SEER）（2004 - 2012年）数据库确定诊断为非转移性sRCC的受试者，并根据其手术治疗方式（ST）分组：未手术或放疗（NSR）；部分肾切除术（PNE）；根治性肾切除术加输尿管切除术和膀胱袖口切除术（RNE + UE + BLAD）；以及根治性肾切除术（RNE）。某些根治性肾切除术病例还接受了辅助外照射放疗（RNE + RAD）。采用Kaplan - Meier法估计总生存期（OS）。使用多变量竞争风险回归分析来计算疾病特异性生存期（DSS）概率，并确定与特定病因死亡率（CSM）相关的因素。
本研究共纳入408例患者。接受手术治疗（即PNE、RNE + UE + BLAD、RNE和RNE + RAD）的患者5年OS和预测DSS显著高于NSR组（分别为20.1 - 54.0%和20.1 - 59.9%）（NSR组分别为9.0%和11.6%）（P < 0.001）。手术治疗与CSM降低独立相关（P < 0.0001）。RNE组和RNE + RAD组之间在OS或1年、3年或5年DSS概率上未观察到显著差异。RNE + RAD与1年CSM降低无显著相关性[亚危险比（SHR）0.95；95%置信区间0.23 - 3.96；P = 0.947]。
辅助外照射放疗未提高非转移性sRCC患者的OS。
