Tanaka Nobuyuki, Mizuno Ryuichi, Ito Keiichi, Shirotake Suguru, Yasumizu Yota, Masunaga Ayako, Ito Yujiro, Miyazaki Yasumasa, Hagiwara Masayuki, Kanao Kent, Mikami Shuji, Nakagawa Ken, Momma Tetsuo, Masuda Takeshi, Asano Tomohiko, Oyama Masafumi, Oya Mototsugu
Department of Urology, Keio University School of Medicine, Tokyo, Japan; Department of Urology, Saitama City Hospital, Saitama, Japan.
Department of Urology, Keio University School of Medicine, Tokyo, Japan.
Eur Urol Focus. 2016 Aug;2(3):303-309. doi: 10.1016/j.euf.2015.11.001. Epub 2015 Dec 2.
Two risk models, the Memorial Sloan Kettering Cancer Center (MSKCC) model and the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) model, have been studied in metastatic renal cell carcinoma (mRCC) treated with targeted therapy.
To validate externally the predictive accuracies of the MSKCC and IMDC models for prognosis in mRCC patients treated with first-line and subsequent second-line targeted therapy.
DESIGN, SETTING, AND PARTICIPANTS: A total of 311 patients were assessed retrospectively.
All patients underwent targeted therapy.
Survival outcomes were assessed using Kaplan-Meier analysis. The predictive ability was evaluated using the c-index.
Regarding to the first-line targeted therapy, the 3-yr overall survival (OS) rates of the MSKCC (p<0.001) and IMDC models (p<0.001) were 76.2% and 77.3%, respectively, in the favorable-risk group; 46.7% and 47.9%, respectively, in the intermediate-risk group; and 13.4% and 15.6%, respectively, in the poor-risk group. The c-indexes were 0.68 for the MSKCC model and 0.69 for the IMDC model in a first-line setting. Regarding the second-line targeted therapy, the 1-yr OS rates of the MSKCC (p<0.001) and IMDC models (p<0.001) were 80.9% and 90.5%, respectively, in the favorable-risk group; 71.4% and 70.6%, respectively, in the intermediate-risk group; and 31.7% and 24.6%, respectively, in the poor-risk group. The c-indexes were 0.66 for the MSKCC model and 0.65 for the IMDC model in the second-line setting. The study is limited by its retrospective nature.
The results may assist physicians in providing more appropriate patient counseling and imply the need for a future prognostic tool in mRCC treated with targeted therapy.
Both risk models were useful for the risk stratification in metastatic renal cell carcinoma (mRCC) patients treated with first-line and second-line targeted therapy; however, it might be necessary to further update or optimize the models for our Japanese cohort of mRCC patients.
两种风险模型，即纪念斯隆凯特琳癌症中心（MSKCC）模型和国际转移性肾细胞癌数据库联盟（IMDC）模型，已在接受靶向治疗的转移性肾细胞癌（mRCC）中进行了研究。
对外验证MSKCC和IMDC模型对接受一线及后续二线靶向治疗的mRCC患者预后的预测准确性。
设计、设置和参与者：共对311例患者进行了回顾性评估。
所有患者均接受靶向治疗。
使用Kaplan-Meier分析评估生存结局。使用c指数评估预测能力。
对于一线靶向治疗，在低危组中，MSKCC模型（p<0.001）和IMDC模型（p<0.001）的3年总生存率（OS）分别为76.2%和77.3%；中危组分别为46.7%和47.9%；高危组分别为13.4%和15.6%。在一线治疗中，MSKCC模型的c指数为0.68，IMDC模型的c指数为0.69。对于二线靶向治疗，在低危组中，MSKCC模型（p<0.001）和IMDC模型（p<0.001）的1年OS率分别为80.9%和90.5%；中危组分别为71.4%和70.6%；高危组分别为31.7%和24.6%。在二线治疗中，MSKCC模型的c指数为0.66，IMDC模型的c指数为0.65。该研究受其回顾性性质的限制。
这些结果可能有助于医生为患者提供更合适的咨询，并表明在接受靶向治疗的mRCC中需要一种未来的预后工具。
两种风险模型对于接受一线和二线靶向治疗的转移性肾细胞癌（mRCC）患者的风险分层均有用；然而，对于我们日本的mRCC患者队列，可能有必要进一步更新或优化这些模型。
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