Bimbatti Davide, Ciccarese Chiara, Fantinel Emanuela, Sava Teodoro, Massari Francesco, Bisogno Iolanda, Romano Mario, Porcaro Antonio, Brunelli Matteo, Martignoni Guido, Mazzarotto Renzo, Artibani Walter, Tortora Giampaolo, Iacovelli Roberto
Medical Oncology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
Department of Oncology, Camposampiero-Cittadella, Padua, Italy.
Urol Oncol. 2018 Dec;36(12):526.e13-526.e18. doi: 10.1016/j.urolonc.2018.08.018. Epub 2018 Oct 6.
Despite important results achieved for metastatic renal cell carcinoma, some patients could benefit from local treatments or an initial active surveillance (AS) period for recurrent disease. We aim to analyze: changes in the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) risk class, the number of metastases and the disease burden from the start of AS to the beginning of systemic therapy; and if these changes influenced patient outcomes.
Patients who started AS at our institution from January 2007 to April 2016 were included. The Kaplan-Meier method was used to estimate total overall survival (tOS) and progression-free survival. Changes in IMDC class, number of metastatic sites, and tumor burden (TB) were evaluated and related to patient survival. Among the patients who started active treatment, progression-free survival and post surveillance OS (psOS) were evaluated.
52 patients were included in the analysis. Median time on AS and tOS were 18.3 and 80.1 months respectively. Baseline factors were not related to the time on AS apart from the IMDC classification (HR = 2.15; 95% CI: 1.19-3.87; P = 0.011). The increase in the number of metastatic sites during AS was correlated with poor tOS (HR = 2.86; 95% CI: 1.29-6.34; P = 0.010). The increase of the TB was a negative prognosis factor for tOS (HR = 1.16; 95% CI: 1.02-1.31; P = 0.024) and psOS (HR = 1.21; 95% CI: 1.07-1.40; P = 0.004). Both IMDC class and change in the TB at the start of therapy were related to psOS. The retrospective nature and the lack of an external review of the imaging are its main limitations.
During AS, patients rarely experience a deterioration of their IMDC prognostic class, and the change in the TB, more than the increase in the number of metastatic sites, may help physicians to make decisions about the early termination of AS and the start of systemic therapy.
尽管转移性肾细胞癌已取得重要成果，但部分患者可能从局部治疗或复发性疾病的初始主动监测（AS）期中获益。我们旨在分析：从AS开始至全身治疗开始时，国际转移性肾细胞癌数据库联盟（IMDC）风险类别、转移灶数量及疾病负担的变化；以及这些变化是否影响患者预后。
纳入2007年1月至2016年4月在本机构开始AS的患者。采用Kaplan-Meier法估计总生存期（tOS）和无进展生存期。评估IMDC类别、转移部位数量及肿瘤负担（TB）的变化，并与患者生存情况相关联。在开始积极治疗的患者中，评估无进展生存期和监测后生存期（psOS）。
52例患者纳入分析。AS期的中位时间和tOS分别为18.3个月和80.1个月。除IMDC分类外，基线因素与AS期时间无关（HR = 2.15；95%CI：1.19 - 3.87；P = 0.011）。AS期间转移部位数量增加与较差的tOS相关（HR = 2.86；95%CI：1.29 - 6.34；P = 0.010）。TB增加是tOS（HR = 1.16；95%CI：1.02 - 1.31；P = 0.024）和psOS（HR = 1.21；95%CI：1.07 - 1.40；P = 0.004）的不良预后因素。IMDC类别和治疗开始时TB的变化均与psOS相关。其主要局限性在于研究的回顾性性质以及缺乏影像学的外部评估。
在AS期间，患者的IMDC预后类别很少恶化，TB的变化而非转移部位数量的增加，可能有助于医生决定AS的早期终止及全身治疗的开始。
