Tasaki Shinsuke, Horiguchi Akio, Asano Takako, Kuroda Kenji, Sato Akinori, Asakuma Junichi, Ito Keiichi, Asano Tomohiko, Asakura Hirotaka
Department of Urology, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan; Department of Urology, Saitama Medical University, Iruma, Saitama 350-0495, Japan.
Department of Urology, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan.
Mol Clin Oncol. 2016 Jul;5(1):69-73. doi: 10.3892/mco.2016.890. Epub 2016 May 9.
The recent discovery and clinical development of targeted agents have expanded treatment options in metastatic renal cell carcinoma (RCC). However, metastatic RCC remains a lethal disease. Complete response is rare and treatment with targeted agents eventually fails in the majority of the patients. Therefore, there is a need for developing a prognostic tool and a novel therapeutic agent for RCC to improve the follow-up strategy after surgical treatment. Clinical data, including patient characteristics, serum fatty acid profile, clinicopathological parameters and clinical outcome, were obtained from 112 patients with RCC prior to surgical treatment. Preoperative fatty acid levels were grouped according to patient characteristics, such as performance status, body mass index or pathological parameters, and were analyzed using the Mann-Whitney U test. Cancer-specific survival in the high and low docosahexaenoic acid (DHA) level groups were compared using the Kaplan-Meier method. Cox proportional hazards models were applied to determine the independent prognostic factors associated with shortened cancer-specific survival. The serum DHA level in patients with metastasis was significantly lower compared with that in patients without metastasis (P=0.047). Low serum DHA level, presence of metastasis and cachexia were independent predictors of shortened cancer-specific survival in a multivariate Cox proportional hazard model (P=0.033, hazard ratio = 4.43). Patients with a serum DHA level below the median value exhibited significantly shorter cancer-specific survival compared with those with a higher serum DHA level (P=0.008). Thus, according to our results, the preoperative serum DHA level may be able to predict the surgical outcome of RCC. However, this finding requires validation by large-scale prospective studies.
靶向药物的最新发现和临床开发扩大了转移性肾细胞癌（RCC）的治疗选择。然而，转移性RCC仍然是一种致命疾病。完全缓解很少见，大多数患者最终会出现靶向药物治疗失败。因此，需要开发一种用于RCC的预后工具和新型治疗药物，以改善手术治疗后的随访策略。从112例手术治疗前的RCC患者中获取临床数据，包括患者特征、血清脂肪酸谱、临床病理参数和临床结局。术前脂肪酸水平根据患者特征进行分组，如体能状态、体重指数或病理参数，并使用Mann-Whitney U检验进行分析。采用Kaplan-Meier方法比较高、低二十二碳六烯酸（DHA）水平组的癌症特异性生存率。应用Cox比例风险模型确定与缩短癌症特异性生存相关的独立预后因素。转移患者的血清DHA水平显著低于无转移患者（P = 0.047）。在多变量Cox比例风险模型中，低血清DHA水平、转移的存在和恶病质是缩短癌症特异性生存的独立预测因素（P = 0.033，风险比 = 4.43）。血清DHA水平低于中位数的患者与血清DHA水平较高的患者相比，癌症特异性生存显著缩短（P = 0.008）。因此，根据我们的结果，术前血清DHA水平可能能够预测RCC的手术结果。然而，这一发现需要通过大规模前瞻性研究进行验证。
