Assi Hazem I, Patenaude Francois, Toumishey Ethan, Ross Laura, Abdelsalam Mahmoud, Reiman Tony
Department of Internal Medicine, Faculty of Medicine, American University of Beirut Medical Centre, American University of Beirut, Lebanon;; Department of Medicine, Dalhousie University, Halifax, NS, Canada;
Segal Cancer Centre, Jewish General Hospital, Department of Oncology and Department of Medicine, Hematology Division, Montreal, QC, Canada;
Can Urol Assoc J. 2016 Mar-Apr;10(3-4):113-9. doi: 10.5489/cuaj.3351.
The primary purpose of this study was to develop a simpler prognostic model to predict overall survival for patients treated for metastatic renal cell carcinoma (mRCC) by examining variables shown in the literature to be associated with survival.
We conducted a retrospective analysis of patients treated for mRCC at two Canadian centres. All patients who started first-line treatment were included in the analysis. A multivariate Cox proportional hazards regression model was constructed using a stepwise procedure. Patients were assigned to risk groups depending on how many of the three risk factors from the final multivariate model they had.
There were three risk factors in the final multivariate model: hemoglobin, prior nephrectomy, and time from diagnosis to treatment. Patients in the high-risk group (two or three risk factors) had a median survival of 5.9 months, while those in the intermediate-risk group (one risk factor) had a median survival of 16.2 months, and those in the low-risk group (no risk factors) had a median survival of 50.6 months.
In multivariate analysis, shorter survival times were associated with hemoglobin below the lower limit of normal, absence of prior nephrectomy, and initiation of treatment within one year of diagnosis.
本研究的主要目的是通过研究文献中显示与生存相关的变量，开发一种更简单的预后模型，以预测转移性肾细胞癌（mRCC）患者的总生存期。
我们对加拿大两个中心接受mRCC治疗的患者进行了回顾性分析。所有开始一线治疗的患者均纳入分析。使用逐步法构建多变量Cox比例风险回归模型。根据患者拥有最终多变量模型中三个风险因素的数量将其分配到风险组。
最终多变量模型中有三个风险因素：血红蛋白、既往肾切除术以及从诊断到治疗的时间。高危组（两个或三个风险因素）患者的中位生存期为5.9个月，中危组（一个风险因素）患者的中位生存期为16.2个月，低危组（无风险因素）患者的中位生存期为50.6个月。
在多变量分析中，生存期较短与血红蛋白低于正常下限、无既往肾切除术以及在诊断后一年内开始治疗有关。
