脑转移的肾癌患者的生存结局得到改善。
Improved Survival Outcomes for Kidney Cancer Patients With Brain Metastases.
机构信息
Kidney Cancer Program, Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX; Division of Hematology and Oncology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX.
Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX.
出版信息
Clin Genitourin Cancer. 2019 Apr;17(2):e263-e272. doi: 10.1016/j.clgc.2018.11.007. Epub 2018 Dec 5.
BACKGROUND
Brain metastases (BM) occur frequently in patients with metastatic kidney cancer and are a significant source of morbidity and mortality. Although historically associated with a poor prognosis, survival outcomes for patients in the modern era are incompletely characterized. In particular, outcomes after adjusting for systemic therapy administration and International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) risk factors are not well-known.
PATIENTS AND METHODS
A retrospective database of patients with metastatic renal cell carcinoma (RCC) treated at University of Texas Southwestern Medical Center between 2006 and 2015 was created. Data relevant to their diagnosis, treatment course, and outcomes were systematically collected. Survival was analyzed by the Kaplan-Meier method. Patients with BM were compared with patients without BM after adjusting for the timing of BM diagnosis, either prior to or during first-line systemic therapy. The impact of stratification according to IMDC risk group was assessed.
RESULTS
A total of 56 (28.4%) of 268 patients with metastatic RCC were diagnosed with BM prior to or during first-line systemic therapy. Median overall survival (OS) for systemic therapy-naive patients with BM compared with matched patients without BM was 19.5 versus 28.7 months (P = .0117). When analyzed according to IMDC risk group, the median OS for patients with BM was similar for favorable- and intermediate-risk patients (not reached vs. not reached; and 29.0 vs. 36.7 months; P = .5254), and inferior for poor-risk patients (3.5 vs. 9.4 months; P = .0462). For patients developing BM while on first-line systemic therapy, survival from the time of progression did not significantly differ by presence or absence of BM (11.8 vs. 17.8 months; P = .6658).
CONCLUSIONS
Survival rates for patients with BM are significantly better than historical reports. After adjusting for systemic therapy, the survival rates of patients with BM in favorable- and intermediate-risk groups were remarkably better than expected and not statistically different from patients without BM, though this represents a single institution experience, and numbers are modest.
背景
脑转移（BM）在转移性肾细胞癌患者中很常见，是发病率和死亡率的重要来源。尽管历史上与预后不良相关，但现代患者的生存结果尚不完全清楚。特别是，在调整系统治疗管理和国际转移性肾细胞癌数据库联盟（IMDC）危险因素后，其结果尚不清楚。
方法
创建了一个回顾性的德克萨斯大学西南医学中心治疗转移性肾细胞癌（RCC）患者的数据库。系统地收集了与他们的诊断、治疗过程和结果相关的数据。通过 Kaplan-Meier 方法分析生存情况。在调整 BM 诊断时间（一线系统治疗前或期间）后，比较有 BM 和无 BM 的患者。评估了根据 IMDC 风险组分层的影响。
结果
在 268 名转移性 RCC 患者中，共有 56 名（28.4%）在一线系统治疗前或期间被诊断为 BM。与匹配的无 BM 患者相比，一线治疗前 BM 的系统治疗初治患者的中位总生存期（OS）为 19.5 个月对 28.7 个月（P=0.0117）。根据 IMDC 风险组分析，BM 患者的中位 OS 对于低危和中危患者相似（未达到 vs. 未达到；29.0 个月 vs. 36.7 个月；P=0.5254），而对于高危患者则较差（3.5 个月 vs. 9.4 个月；P=0.0462）。对于在一线系统治疗期间发生 BM 的患者，从进展时开始的生存时间，有无 BM 之间没有显著差异（11.8 个月对 17.8 个月；P=0.6658）。
结论
BM 患者的生存率明显好于历史报告。在调整系统治疗后，低危和中危组 BM 患者的生存率明显好于预期，与无 BM 患者无统计学差异，尽管这是单机构经验，且患者数量有限。
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