Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Immunogenomics and Precision Oncology Platform, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Computational Oncology Service, Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA.
Eur Urol Oncol. 2020 Feb;3(1):47-56. doi: 10.1016/j.euo.2019.10.002. Epub 2019 Nov 14.
One of the main challenges in the management of renal cell carcinoma (RCC) is risk-stratifying patients who present with metastatic disease. Tumor size is an important predictor of survival in the localized setting; however, this feature has not been explored fully in patients presenting with M1 RCC.
To assess the impact of tumor size on survival in patients with metastatic RCC who underwent cytoreductive nephrectomy (CN).
DESIGN, SETTING, AND PARTICIPANTS: We queried the Memorial Sloan Kettering (MSK) nephrectomy database for patients who presented with M1 disease and underwent CN between 1989 and 2016 (n=304). Primary tumor size was obtained from pathology reports. Data from the International Metastatic Database Consortium (IMDC) were used for validation purposes (n=778).
Overall survival (OS) estimates were computed using the Kaplan-Meier method. Cox regressions were used to test the association between tumor size and OS in univariate and multivariable analyses. Tumors ≤4cm were compared with larger masses. Secondary analyses were performed to assess the robustness of these findings.
Clear cell tumors ≤4cm were significantly associated with improved OS in both the MSK (hazard ratio [HR]: 0.35, 0.17-0.72, p= 0.004) and IMDC (HR 0.54, 0.36-0.83, p= 0.004) cohorts. The association was observed even after adjusting for known prognostic factors (HR 0.40, 0.14-1.14, p= 0.09 and HR: 0.54, 0.33-0.90, p= 0.02 in the MSK and IMDC cohorts, respectively). Limitations of this study include the absence of patients who were considered poor surgical candidates as well as potential selection bias.
The primary tumor size ≤4cm was independently associated with improved OS in patients with metastatic clear cell RCC who underwent CN. Additionally, the association between primary size and survival was found to be nonlinear. These findings suggest that there is a group of small metastatic RCCs that can convey a better overall prognosis. The potential role of primary tumor size when risk stratifying patients with M1 RCC should be explored further to determine its utility during clinical decision making.
We evaluated the impact of small tumor size on prognosis in patients with metastatic kidney cancer who undergo removal of the primary tumor. Very small masses (≤4cm) were associated with better prognosis in patients with clear cell tumors.
在肾细胞癌（RCC）的管理中，面临的主要挑战之一是对转移性疾病患者进行风险分层。肿瘤大小是局部治疗中生存的重要预测因素；然而，在患有 M1 RCC 的患者中，尚未对此特征进行充分的研究。
评估在接受细胞减灭性肾切除术（CN）的转移性 RCC 患者中，肿瘤大小对生存的影响。
设计、设置和参与者：我们从 1989 年至 2016 年期间在纪念斯隆凯特琳癌症中心（MSK）的肾切除术数据库中查询了患有 M1 疾病并接受 CN 的患者（n=304）。从病理报告中获取原发肿瘤大小。国际转移性数据库联盟（IMDC）的数据用于验证目的（n=778）。
使用 Kaplan-Meier 方法计算总生存期（OS）估计值。使用 Cox 回归在单变量和多变量分析中测试肿瘤大小与 OS 之间的关联。将肿瘤大小≤4cm 的患者与更大的肿瘤进行比较。进行了二次分析以评估这些发现的稳健性。
在 MSK（危险比[HR]：0.35，0.17-0.72，p=0.004）和 IMDC（HR：0.54，0.36-0.83，p=0.004）队列中，≤4cm 的透明细胞肿瘤与改善的 OS 显著相关。即使在调整了已知的预后因素后，这种关联仍然存在（在 MSK 和 IMDC 队列中，HR 0.40，0.14-1.14，p=0.09 和 HR：0.54，0.33-0.90，p=0.02）。本研究的局限性包括未包括被认为是手术不佳的患者以及潜在的选择偏倚。
在接受 CN 的转移性透明细胞 RCC 患者中，原发肿瘤大小≤4cm 与 OS 改善独立相关。此外，原发大小与生存之间的关联是非线性的。这些发现表明，有一组较小的转移性 RCC 可以提供更好的总体预后。应进一步探讨原发肿瘤大小在 M1 RCC 患者分层风险中的作用，以确定其在临床决策中的效用。
我们评估了肿瘤大小对接受原发性肿瘤切除术的转移性肾癌患者预后的影响。非常小的肿瘤（≤4cm）与透明细胞肿瘤患者的预后较好相关。
