Department of Urology, Center for Prostate Cancer, National Cancer Center, Goyang, Korea.
Biometrics Research Branch, Division of Cancer Epidemiology and Prevention, Research Institute and Hospital of National Cancer Center, Goyang, Korea.
PLoS One. 2019 Feb 20;14(2):e0211105. doi: 10.1371/journal.pone.0211105. eCollection 2019.
This study aimed to determine the prognostic factors of progression-free survival (PFS) and overall survival (OS) in non-nephrectomized patients with synchronous metastatic renal cell carcinoma (mRCC) receiving first-line vascular endothelial growth factor (VEGF)-targeted therapy or immunotherapy.
Of 70 patients, 57 (81.4%) were treated with targeted therapy, including 5 (7.1%) with previous immunotherapy and 13 (18.6%) with immunotherapy only. The medical records of patients were retrospectively reviewed and analyzed to determine factors of PFS and OS using the Cox proportional hazards model with a statistical significance p-value <0.05.
The median treatment and follow-up periods were 3.9 and 30.9 months, respectively. Disease progression was reported in 90.0% of patients, with an objective response rate and clinical benefit rate of 26.1% and 76.8%, respectively. The lung (77.1%) was the most common site of metastasis. Multivariable analysis showed that poor Heng risk (hazard ratio [HR]: 2.37) and liver metastasis (HR: 2.34) were significant prognostic factors for PFS, and female sex (HR: 2.13), poor Heng risk (HR: 3.14), and liver metastasis (HR: 2.78) were significant prognostic factors for OS (p < 0.05). A subset analysis of risk factors among patients without previous history of immunotherapy also showed poor Heng risk (HR 2.92 and HR 4.24 for PFS) and liver metastasis (HR 2.87 and HR 4.81 for OS) as significant factors for both PFS and OS (p<0.05).
Poor Heng risk, sex, and liver metastasis were associated with survival outcomes after first-line systemic therapy in patients with non-nephrectomized synchronous mRCC.
本研究旨在确定接受一线血管内皮生长因子（VEGF）靶向治疗或免疫治疗的非肾切除术同步转移性肾细胞癌（mRCC）患者无进展生存期（PFS）和总生存期（OS）的预后因素。
70 例患者中，57 例（81.4%）接受靶向治疗，其中 5 例（7.1%）既往接受过免疫治疗，13 例（18.6%）仅接受免疫治疗。回顾性分析患者病历，采用 Cox 比例风险模型分析 PFS 和 OS 的影响因素，以 p 值<0.05 为统计学意义。
中位治疗和随访时间分别为 3.9 和 30.9 个月。90.0%的患者报告疾病进展，客观缓解率和临床获益率分别为 26.1%和 76.8%。肺部（77.1%）是最常见的转移部位。多变量分析显示，不良 Heng 风险（风险比 [HR]：2.37）和肝转移（HR：2.34）是 PFS 的显著预后因素，女性（HR：2.13）、不良 Heng 风险（HR：3.14）和肝转移（HR：2.78）是 OS 的显著预后因素（p<0.05）。无既往免疫治疗史患者的风险因素亚组分析也显示，不良 Heng 风险（PFS 的 HR 为 2.92 和 4.24）和肝转移（OS 的 HR 为 2.87 和 4.81）是 PFS 和 OS 的显著因素（p<0.05）。
非肾切除术同步 mRCC 患者一线系统治疗后，不良 Heng 风险、性别和肝转移与生存结局相关。
