Lindskog Magnus, Wahlgren Thomas, Sandin Rickard, Kowalski Jan, Jakobsson Maria, Lundstam Sven, Ljungberg Börje, Harmenberg Ulrika
Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.
Pfizer AB, Sollentuna, Sweden.
Urol Oncol. 2017 Sep;35(9):541.e15-541.e22. doi: 10.1016/j.urolonc.2017.05.013. Epub 2017 Jun 13.
This retrospective study investigated overall survival (OS) and factors influencing OS in Swedish patients with metastatic renal cell carcinoma (mRCC) during the pre- (2002-2005), early (2006-2008), and late (2009-2012) targeted therapy (TT) era.
Three national Swedish registries identified patients with mRCC. Median OS was estimated using the Kaplan-Meier method. Multivariate analysis was performed using Cox proportional hazards regression. Subgroup analysis was conducted for patients with synchronous metastases (M1) and the elderly (aged≥75y).
A total of 4,217 patients with mRCC were identified, including 1,533 patients with M1 and 1,275 elderly patients. For patients with mRCC diagnosed in 2002 to 2005, 2006 to 2008, and 2009 to 2012, median OS was 10.0, 13.0, and 18.0 months. Similarly, median OS improved in the M1 and elderly populations. Elderly patients were less likely to be prescribed TT (≥75 vs.<75y): 18.3 vs. 63.5% (in 2006-2008) and 28.6% vs. 55.9% (in 2009-2012). Diagnosis of mRCC in 2009 to 2012, nephrectomy and TT prescription were associated with improved OS in the total mRCC, M1, and elderly populations.
This real-world study showed continued significant improvement in mRCC OS during the late TT era, including in M1 and elderly populations. TT should be considered for all patients with mRCC based on tolerability, regardless of age.
这项回顾性研究调查了瑞典转移性肾细胞癌(mRCC)患者在靶向治疗(TT)时代前期(2002 - 2005年)、早期(2006 - 2008年)和后期(2009 - 2012年)的总生存期(OS)及影响OS的因素。
瑞典三个国家级登记处确定了mRCC患者。采用Kaplan - Meier方法估计中位OS。使用Cox比例风险回归进行多变量分析。对同时性转移(M1)患者和老年患者(年龄≥75岁)进行亚组分析。
共确定了4217例mRCC患者,包括1533例M1患者和1275例老年患者。2002年至2005年、2006年至2008年以及2009年至2012年诊断为mRCC的患者,中位OS分别为10.0个月、13.0个月和18.0个月。同样,M1人群和老年人群的中位OS也有所改善。老年患者接受TT治疗的可能性较小(≥75岁与<75岁相比):2006 - 2008年为18.3%对63.5%,2009 - 2012年为28.6%对55.9%。2009年至2012年诊断为mRCC、肾切除术和TT治疗处方与总mRCC人群、M1人群和老年人群的OS改善相关。
这项真实世界研究表明,在TT时代后期,mRCC的OS持续显著改善,包括M1人群和老年人群。基于耐受性,所有mRCC患者无论年龄大小均应考虑接受TT治疗。