Syed Mohsan Ali, Nieder Carsten
Department of Oncology and Palliative Medicine, Nordland Hospital, Bodo 8092, Norway.
Department of Oncology and Palliative Medicine, Nordland Hospital, Bodo 8092, Norway; Department of Clinical Medicine, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromso 9037, Norway.
J Clin Med Res. 2017 Apr;9(4):281-288. doi: 10.14740/jocmr2839w. Epub 2017 Feb 21.
Patients with metastatic renal cell carcinoma (mRCC) have variable survival outcomes. When discussing management approaches and providing information to patients and caregivers, it is important to have realistic perspectives, especially if the expected prognosis is very unfavorable. In the present study, factors predicting this endpoint were analyzed.
Data from 60 patients treated in routine clinical practice were evaluated. Unfavorable prognosis was defined as death within approximately 3 months from diagnosis of mRCC (maximum 3.5 months). Baseline factors including laboratory values and management approach were compared between the groups with short and longer survival.
A total of 48 patients (80%) experienced ≥ 4 months survival (4+MS) and 10 (16.7%) experienced shorter survival (3MS). The others had short follow-up. Adverse prognostic factors that were significantly more frequent in the 3MS group were low hemoglobin, high lactate dehydrogenase and lack of systemic therapy. We used these three items to create a prognostic model: score 0 = no adverse factors, score 1 = one adverse factor, score 2 = two adverse factors, score 3 = three adverse factors. In the score 0 group, one out of 20 patients experienced 3MS (5%). In score 1, two out of 21 patients belonged to the 3MS group (9.5%). For score 2, the corresponding figure was four out of 14 patients (29%). In the score 3 group, three out of three patients experienced 3MS (100%) (P = 0.0001).
A simple model with three prognostic factors predicted survival of patients with newly diagnosed mRCC. Additional validation in other databases is warranted.
转移性肾细胞癌（mRCC）患者的生存结果各不相同。在讨论治疗方法并向患者及护理人员提供信息时，拥有现实的观点很重要，尤其是在预期预后非常不利的情况下。在本研究中，分析了预测这一终点的因素。
评估了60例在常规临床实践中接受治疗的患者的数据。不良预后定义为自mRCC诊断起约3个月内死亡（最长3.5个月）。比较了生存时间短和长的两组患者的基线因素，包括实验室检查值和治疗方法。
共有48例患者（80%）生存时间≥4个月（4 + MS），10例（16.7%）生存时间较短（3MS）。其他患者随访时间短。3MS组中显著更常见的不良预后因素为血红蛋白水平低、乳酸脱氢酶水平高和未进行全身治疗。我们使用这三个指标创建了一个预后模型：评分0 = 无不良因素，评分1 = 一个不良因素，评分2 = 两个不良因素，评分3 = 三个不良因素。在评分0组中，20例患者中有1例经历了3MS（5%）。在评分1组中，21例患者中有2例属于3MS组（9.5%）。对于评分2组，相应数字为14例患者中有4例（29%）。在评分3组中，3例患者中有3例经历了3MS（100%）（P = 0.0001）。
一个包含三个预后因素的简单模型可预测新诊断mRCC患者的生存情况。有必要在其他数据库中进行进一步验证。
