Department of Urology, Yamagata University Faculty of Medicine, Iida-nishi 2-2-2, Yamagata, 990-9585, Japan.
Sci Rep. 2019 Oct 29;9(1):15451. doi: 10.1038/s41598-019-51305-7.
Data on the outcomes of third- or fourth-line therapy for metastatic renal cell carcinoma (mRCC) are limited. The aim of our study was to evaluate the efficacy of therapy beyond the second line. We retrospectively analysed data of mRCC patients who underwent systemic therapy at Yamagata University Hospital. The best objective response (BOR), response rate (RR), and progression-free survival (PFS) were assessed for each line of treatment. To investigate the correlation between overall survival (OS) and the number of treatment lines during a patient's lifetime, the median OS was assessed using univariate and multivariate analyses. In the first-, second-, and third-line therapies, approximately 20% of patients had long PFS of >15 months. In targeted treatments beyond the third line, only one treatment suppressed disease progression for >10 months. Among patients who died during the follow-up period, those treated with triple and quadruple lines had similar OS (42.5 months vs. 48.4 months, respectively). Multivariate analysis showed that patients with triple or more lines of therapy had better OS; however, quadruple or more lines of therapy was not an independent prognostic factor. We concluded that third-line systemic therapy could improve OS; however, fourth-line therapy could not.
转移性肾细胞癌（mRCC）三线或四线治疗结局的数据有限。本研究旨在评估二线以上治疗的疗效。我们回顾性分析了在山形大学医院接受系统治疗的 mRCC 患者的数据。评估了每条治疗线的最佳客观缓解（BOR）、缓解率（RR）和无进展生存期（PFS）。为了研究患者一生中的治疗线数与总生存期（OS）之间的相关性，采用单因素和多因素分析评估了 OS 的中位数。在一线、二线和三线治疗中，约 20%的患者 PFS 长于 15 个月。在三线以上的靶向治疗中，只有一种治疗方法能使疾病进展得到抑制 10 个月以上。在随访期间死亡的患者中，接受三联或四联治疗的患者 OS 相似（分别为 42.5 个月和 48.4 个月）。多因素分析显示，接受三线或更多线治疗的患者 OS 更好；然而，四线或更多线治疗不是独立的预后因素。我们得出结论，三线系统治疗可改善 OS；然而，四线治疗不能。
