Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Department of Urology, Korea University College of Medicine, Seoul, Republic of Korea.
J Urol. 2018 Nov;200(5):989-995. doi: 10.1016/j.juro.2018.06.030. Epub 2018 Jun 22.
In this study we evaluated conditional survival probabilities in patients with metastatic renal cell carcinoma who underwent first line tyrosine kinase inhibitor therapy. We also identified predictors of conditional survival with time.
We retrospectively reviewed clinical data on 1,659 individuals with metastatic renal cell carcinoma in the Korean Renal Cancer Study Group database, of whom the records of 1,131 were finally analyzed. The primary end point was conditional overall survival. Kaplan-Meier survival analysis was used to calculate conditional overall survival probabilities using the formula, conditional survival (α│β) = S(α + β)/S(β), indicating the likelihood of additional α years survivorship in person who has already survived for β years after initial therapy. S(χ) represents the actual survival rate. Multivariate Cox regression model was used to identify predictors of conditional survival with time.
Six, 12, 18, 24 and 36-month conditional overall survival gradually increased in patients at all additional survival times after initial treatment compared to patient baseline survival estimations. While the actual overall survival rate decreased with time, the 36-month conditional overall survival rate was calculated as 7.3% higher in patients who had already survived 36 months compared to baseline estimations at the time of initial tyrosine kinase inhibitor treatment. Furthermore, predictors of conditional overall survival changed with time. Only previous metastasectomy remained a key prognosticator of conditional overall survival until 36 months of survival following initial tyrosine kinase inhibitor treatment.
Conditional survival improved with time after initial tyrosine kinase inhibitor treatment in patients with metastatic renal cell carcinoma. Our study offers valuable information for practical survival estimations and relevant prognosticators in patients with metastatic renal cell carcinoma who receive first line tyrosine kinase inhibitor.
本研究评估了接受一线酪氨酸激酶抑制剂治疗的转移性肾细胞癌患者的条件生存概率。我们还确定了随时间变化的条件生存的预测因素。
我们回顾性分析了韩国肾癌研究组数据库中 1659 例转移性肾细胞癌患者的临床资料，其中最终分析了 1131 例患者的记录。主要终点是条件总生存。Kaplan-Meier 生存分析用于通过公式计算条件总生存概率，条件生存（α│β）= S（α+β）/S（β），表示初始治疗后已经存活β年的患者在额外α年内存活的可能性。S（χ）表示实际生存率。多变量 Cox 回归模型用于确定随时间变化的条件生存的预测因素。
与患者基线生存估计相比，所有额外生存时间的患者在初始治疗后 6、12、18、24 和 36 个月的条件总生存逐渐增加。虽然实际总生存率随时间降低，但与初始酪氨酸激酶抑制剂治疗时的基线估计相比，已经存活 36 个月的患者的 36 个月条件总生存率计算为高出 7.3%。此外，条件总生存的预测因素随时间而变化。只有既往转移灶切除术仍然是初始酪氨酸激酶抑制剂治疗后 36 个月内条件总生存的关键预后因素。
在接受一线酪氨酸激酶抑制剂治疗的转移性肾细胞癌患者中，初始治疗后条件生存随时间改善。我们的研究为接受一线酪氨酸激酶抑制剂治疗的转移性肾细胞癌患者的实际生存估计和相关预后因素提供了有价值的信息。
