Moreira Daniel M, Gershman Boris, Lohse Christine M, Boorjian Stephen A, Cheville John C, Leibovich Bradley C, Thompson Robert Houston
Department of Urology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Division of Biomedical Statistics and Informatics, Mayo Foundation for Medical Education and Research, Mayo Clinic, Rochester, MN, USA.
World J Urol. 2016 Oct;34(10):1465-72. doi: 10.1007/s00345-016-1793-7. Epub 2016 Feb 25.
To analyze the association of paraneoplastic syndromes (PNS) with progression-free (PFS) and cancer-specific survival (CSS) among patients with renal cell carcinoma (RCC) undergoing nephrectomy.
We performed a retrospective analysis of 2865 patients undergoing nephrectomy for localized RCC at Mayo Clinic from 1990 to 2010. PNS analyzed were anemia, polycythemia, hypercalcemia, recent-onset hypertension, and liver dysfunction. PFS and CSS were estimated using Kaplan-Meier method and compared with Cox proportional hazard models, unadjusted and adjusted for clinicopathologic features.
A total of 661 (23 %) patients had anemia, 37 (1 %) had polycythemia, 177 (9 %) had hypercalcemia, 51 (2 %) had recent-onset hypertension, and 224 (10 %) had liver dysfunction at time of nephrectomy. Patients with PNS were more likely to have high-grade tumors and advanced disease stages. A total of 675 (24 %) patients developed progression and 1171 (41 %) died of RCC, over a median follow-up of 8.2 years. On univariable analysis, the presence of any PNS was associated with inferior CSS [hazard ratio (HR) = 1.86, p = 0.007] and a trend toward shorter PFS (HR = 1.33, p = 0.07) compared with patients without PNS. Specifically, anemia, polycythemia, hypercalcemia, and liver dysfunction were each associated with inferior CSS and PFS (all p < 0.05). However, on multivariable analysis PNS (overall or each individual syndrome) did not remain independently associated with CSS or PFS.
Patients with RCC undergoing nephrectomy presenting with PNS have worse oncologic outcome than those with incidentally found tumors. However, the adverse outcome among PNS patients seems to be largely explained by adverse pathologic features of these tumors.
分析接受肾切除术的肾细胞癌（RCC）患者中副肿瘤综合征（PNS）与无进展生存期（PFS）和癌症特异性生存期（CSS）之间的关联。
我们对1990年至2010年在梅奥诊所接受局限性RCC肾切除术的2865例患者进行了回顾性分析。分析的PNS包括贫血、红细胞增多症、高钙血症、近期发生的高血压和肝功能障碍。使用Kaplan-Meier方法估计PFS和CSS，并与Cox比例风险模型进行比较，未调整以及针对临床病理特征进行调整。
共有661例（23%）患者存在贫血，37例（1%）有红细胞增多症，177例（9%）有高钙血症，51例（2%）有近期发生的高血压，224例（10%）在肾切除时存在肝功能障碍。患有PNS的患者更有可能患有高级别肿瘤和疾病晚期。在中位随访8.2年期间，共有675例（24%）患者出现疾病进展，1171例（41%）死于RCC。单因素分析显示，与无PNS的患者相比，任何PNS的存在均与较差的CSS相关[风险比（HR）=1.86，p=0.007]，且有PFS缩短的趋势（HR=1.33，p=0.07）。具体而言，贫血、红细胞增多症、高钙血症和肝功能障碍均与较差的CSS和PFS相关（所有p<0.05）。然而，多因素分析显示PNS（总体或每种单独的综合征）与CSS或PFS不再独立相关。
接受肾切除术的RCC患者伴有PNS时，其肿瘤学结局比偶然发现肿瘤的患者更差。然而，PNS患者的不良结局似乎很大程度上是由这些肿瘤的不良病理特征所解释。
