Department of Urology, Peking University People's Hospital, Beijing, 100044, China.
Department of Clinical Epidemiology, Peking University People's Hospital, Beijing, 100044, China.
Eur J Surg Oncol. 2019 Jul;45(7):1246-1252. doi: 10.1016/j.ejso.2019.01.221. Epub 2019 Feb 1.
Knowledge of clear cell renal cell carcinoma bone metastasis (ccRCC-BM) remains scarce. This study depicts clinical, pathological and outcome features of the disease and provides suggestions to establish prognosis prediction system more appropriate for ccRCC-BM.
Patients with ccRCC-BM had clinical, pathological data collected. Kaplan-Meier survival analysis was used for outcome profiles. Prognostic risks were evaluated using MSKCC/Motzer score. Univariate and multivariate logistic regression were performed to investigate association between clinical, pathological features and prognosis.
In the series containing 106 ccRCC-BM patients with 4:1 male predominance, 44.3% of them had synchronous bone metastasis and 28.3% had multi-organ metastasis. Axial bone was prone to bone metastasis and the incidence of severe skeletal-related events was 54.7%. Curative bone lesion resection was performed in 70.7% patients. The median overall survival (mOS) time was 45 months for all and 32 months for those in unfavorable risk stratification. Shorter time to bone metastasis (TTBM) [OR 1.019, 95% CI (1.007, 1.031)], elderly age [OR 1.040, 95% CI (1.001, 1.080)], concomitant multi-organ metastasis [OR 3.883, 95% CI (1.375, 10.967)] and carbonic anhydrase (CA)-IX expression loss [OR 58.824, 95% CI (2.653, 1000)] were associated with poor prognosis.
The outcome of ccRCC-BM remained poor in unfavorable risk stratification. Bone lesion resection accompanied by systematic therapy for selected patient could improve prognosis. Shorter TTBM, elderly age, concomitant multi-organ metastasis and the expression loss of CA-IX along with gender-bias, feasibility for surgical treatment are suggested to be incorporated in modified ccRCC-BM-specific prognosis prediction system.
透明细胞肾细胞癌骨转移（ccRCC-BM）的相关知识仍然匮乏。本研究描述了该疾病的临床、病理和预后特征，并提出了建立更适合 ccRCC-BM 的预后预测系统的建议。
收集了 106 例 ccRCC-BM 患者的临床和病理数据。采用 Kaplan-Meier 生存分析评估预后。采用 MSKCC/Motzer 评分评估预后风险。采用单因素和多因素逻辑回归分析探讨临床和病理特征与预后的关系。
在该系列中，男性患者明显多于女性（4:1），44.3%的患者为同时性骨转移，28.3%的患者为多器官转移。轴性骨更易发生骨转移，严重骨骼相关事件的发生率为 54.7%。70.7%的患者接受了根治性骨病变切除术。所有患者的中位总生存期（mOS）为 45 个月，而预后不良风险分层患者的 mOS 为 32 个月。骨转移时间较短（TTBM）[OR 1.019，95%CI（1.007，1.031）]、年龄较大（OR 1.040，95%CI（1.001，1.080）]、合并多器官转移（OR 3.883，95%CI（1.375，10.967）]和碳酸酐酶（CA）-IX 表达缺失（OR 58.824，95%CI（2.653，1000）]与预后不良相关。
预后不良风险分层的 ccRCC-BM 患者预后仍然较差。对于选择的患者，骨病变切除术联合系统治疗可改善预后。较短的 TTBM、年龄较大、合并多器官转移以及 CA-IX 表达缺失，加上性别倾向、手术可行性，提示可能需要纳入改良的 ccRCC-BM 特异性预后预测系统。
