Marchioni Michele, Bandini Marco, Pompe Raisa S, Tian Zhe, Martel Tristan, Kapoor Anil, Cindolo Luca, Berardinelli Francesco, Briganti Alberto, Shariat Shahrokh F, Schips Luigi, Karakiewicz Pierre I
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada.
Department of Urology, SS Annunziata Hospital, "G.D'Annunzio" University of Chieti, Chieti, Italy.
Int Urol Nephrol. 2017 Dec;49(12):2143-2149. doi: 10.1007/s11255-017-1703-y. Epub 2017 Sep 20.
To examine the effect of diagnosis year, defined as contemporary (2010-2014), intermediate (2006-2009) and historical (2001-2005) on cancer-specific mortality (CSM) in patients with metastatic renal cell carcinoma (mRCC).
Within Surveillance, Epidemiology, and End Results registry (2001-2014), we identified patients with mRCC. Cumulative incidence and competing risks regression (CRR) models examined CSM, after accounting for other-cause mortality. Finally, we performed subgroup analyses according to histological subtype: clear-cell mRCC (ccmRCC) versus non-ccmRCC.
We identified 15,444 patients with mRCC. Of those, 41.0, 28.7 and 30.3% were diagnosed, respectively, in the contemporary, intermediate and historical years. Of all, 47.1, 5.3 and 47.6% were, respectively, ccmRCC, non-ccmRCC and other mRCC histological variants [sarcomatoid mRCC, cyst-associated mRCC, collecting duct carcinoma and mRCC not otherwise specified (NOS)]. Overall, 24-month CSM rates were, respectively, 61.0, 63.7 and 67.3% in contemporary, intermediate and historical patients. In all patients, multivariable CRR models exhibited higher CSM in intermediate (HR 1.11; p < 0.001) and historical patients (HR 1.24; p < 0.001) than in contemporary patients. Multivariable CRR models focusing on ccmRCC yielded virtually the same results. However, multivariable CRR models focusing on non-ccmRCC showed no CSM differences according to diagnosis year (all p ≥ 0.3).
The introduction of new therapeutic agents resulted in CSM-free survival improvement over study time. However, this effect exclusively applies to patients with ccmRCC, but not to those with non-ccmRCC. This observation is in agreement with established efficacy of systemic therapies for ccmRCC, but lesser efficacy of these agents for non-ccmRCC.
研究诊断年份（定义为当代（2010 - 2014年）、中期（2006 - 2009年）和历史时期（2001 - 2005年））对转移性肾细胞癌（mRCC）患者癌症特异性死亡率（CSM）的影响。
在监测、流行病学和最终结果登记处（2001 - 2014年）中，我们确定了mRCC患者。累积发病率和竞争风险回归（CRR）模型在考虑其他原因导致的死亡率后，对CSM进行了研究。最后，我们根据组织学亚型进行了亚组分析：透明细胞mRCC（ccmRCC）与非ccmRCC。
我们确定了15444例mRCC患者。其中，分别有41.0%、28.7%和30.3%在当代、中期和历史时期被诊断。总体而言，47.1%、5.3%和47.6%分别为ccmRCC、非ccmRCC和其他mRCC组织学变体[肉瘤样mRCC、囊肿相关性mRCC、集合管癌和未另行指定（NOS）的mRCC]。总体而言，当代、中期和历史时期患者的24个月CSM率分别为61.0%、63.7%和67.3%。在所有患者中，多变量CRR模型显示中期（HR 1.11；p < 0.001）和历史时期患者（HR 1.24；p < 0.001）的CSM高于当代患者。关注ccmRCC的多变量CRR模型得出了几乎相同的结果。然而，关注非ccmRCC的多变量CRR模型显示，根据诊断年份，CSM没有差异（所有p≥0.3）。
新治疗药物的引入使无CSM生存率在研究期间有所提高。然而，这种效果仅适用于ccmRCC患者，不适用于非ccmRCC患者。这一观察结果与ccmRCC全身治疗的既定疗效一致，但这些药物对非ccmRCC的疗效较差。
