Buchler Tomas, Poprach Alexandr, Bortlicek Zbynek, Lakomy Radek, Chloupková Renata, Vyzula Rostislav, Zemanova Milada, Kopeckova Katerina, Svoboda Marek, Slaby Ondrej, Kiss Igor, Studentova Hana, Hornova Jana, Fiala Ondrej, Kopecky Jindrich, Finek Jindrich, Dusek Ladislav, Melichar Bohuslav
Department of Oncology, First Faculty of Medicine, Charles University and Thomayer University Hospital, Videnska, Prague, Czech Republic.
Department of Comprehensive Cancer Care and Faculty of Medicine, Masaryk Memorial Cancer Institute and Masaryk University, Brno, Czech Republic.
Clin Genitourin Cancer. 2017 Dec;15(6):e1047-e1053. doi: 10.1016/j.clgc.2017.06.006. Epub 2017 Jun 29.
Although targeted therapies with inhibitors of the vascular endothelial growth factor (VEGF) are the mainstay of treatment for metastatic renal cell carcinoma, there are limited data on the outcome of patients with long-term response to this treatment.
In a retrospective, registry-based study, patients continuously treated with first-line anti-VEGF agents for at least 24 months were included. In total, 219 patients had evaluable data and were included in the outcome analysis.
Median progression-free survival (PFS) after initiation of first-line targeted therapy was 39.7 months (95% confidence interval [CI], 35.9-43.5 months), with 5-year PFS of 34.2% (95% CI, 27.2%-41.2%). Median overall survival (OS) reached 79.1 months (95% CI, 65.2-93.0 months) with the 5-year OS of 62.1% (95% CI, 54.5%-69.7%). In this cohort, 28, 103, and 88 patients achieved complete response (CR), partial response (PR), or stable disease (SD) as the best response, respectively. Median PFS and OS were comparable in patients with PR and SD, but significantly longer in patients with CR (log rank test P value for PFS difference < .001 and .009 for OS difference).
There are marked differences in PFS and OS between patients who receive long-term anti-VEGF treatment, achieving CR and non-CR as the best clinical response. Patients with non-CR experienced a relatively high progression rate shortly after the landmark time point of 2 years.
尽管使用血管内皮生长因子（VEGF）抑制剂的靶向治疗是转移性肾细胞癌的主要治疗方法，但关于长期对该治疗有反应的患者的预后数据有限。
在一项基于登记处的回顾性研究中，纳入了连续接受一线抗VEGF药物治疗至少24个月的患者。共有219例患者有可评估数据并纳入了预后分析。
一线靶向治疗开始后的中位无进展生存期（PFS）为39.7个月（95%置信区间[CI]，35.9 - 43.5个月），5年PFS为34.2%（95%CI，27.2% - 41.2%）。中位总生存期（OS）达到79.1个月（95%CI，65.2 - 93.0个月），5年OS为62.1%（95%CI，54.5% - 69.7%）。在该队列中，分别有28例、103例和88例患者达到完全缓解（CR）、部分缓解（PR）或疾病稳定（SD）作为最佳反应。PR和SD患者的中位PFS和OS相当，但CR患者显著更长（PFS差异的对数秩检验P值<0.001，OS差异的P值为0.009）。
接受长期抗VEGF治疗且最佳临床反应为CR和非CR的患者在PFS和OS方面存在显著差异。非CR患者在2年这个标志性时间点后不久进展率相对较高。
