系统治疗对伴或不伴脑转移的转移性肾细胞癌患者的影响。
Impact of Systemic Therapy in Metastatic Renal-Cell Carcinoma Patients With Synchronous and Metachronous Brain Metastases.
机构信息
Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
出版信息
Clin Genitourin Cancer. 2020 Jun;18(3):e224-e232. doi: 10.1016/j.clgc.2019.10.024. Epub 2019 Nov 6.
BACKGROUND
Modern radiation techniques have led to significant improvements in intracranial disease control and overall survival (OS) for metastatic renal-cell carcinoma (mRCC) patients diagnosed with brain metastases (BM). The impact of systemic therapy in patients developing mRCC BM remains undercharacterized.
PATIENTS AND METHODS
We performed a retrospective cohort study of mRCC patients diagnosed with BM. Patients were grouped as having either metachronous BM (ie, ≥ 3 months from mRCC diagnosis) or synchronous BM (ie, < 3 months from mRCC diagnosis). Details of patient demographics, BM, systemic therapy, and outcomes were extracted. Statistical analysis comprised chi-square tests, analysis of variance, and Kaplan-Meier method to characterize survival outcomes.
RESULTS
Seventy-four patients were identified (40 at ≥ 3 months from mRCC diagnosis and 34 at < 3 months from mRCC diagnosis) of which 72 (97%) received local therapy for their BM. Median (interquartile range [IQR]) duration while first line treatment was longer at 7.8 (3.6-17.0) versus 5.1 (3.3-12.6) in patients with metachronous BM versus patients with synchronous BM (P = 0.6), respectively. After BM diagnosis, the metachronous BM cohort continued to receive the same systemic therapy for a median (IQR) duration of 1.9 (0.4-5.5) months, with eventual change most commonly the result of extracranial disease progression. Median (IQR) OS from mRCC diagnosis favored metachronous BM patients versus synchronous BM patients, at 64.2 (31.4-not yet reached) versus 22.4 (9.7-34.1) months (P = .003), respectively. However, this was not significantly different from the time of BM diagnosis, with median (IQR) survival of 20.6 (9.2-31.2) versus 15.7 (11.6-not yet reached) months (P = .95), respectively.
CONCLUSION
Prolonged OS was found for mRCC patients with BM that presented either metachronously or synchronously. For patients diagnosed with metachronous BM, the development of BM may be an early sign of systemic therapy failure.
背景
现代放射技术显著提高了颅内疾病控制和转移性肾细胞癌（mRCC）伴脑转移（BM）患者的总生存率（OS）。mRCC 伴 BM 患者接受系统治疗的影响仍未得到充分描述。
方法
我们对 mRCC 伴 BM 患者进行了回顾性队列研究。将患者分为异时性 BM（即 mRCC 诊断后≥3 个月）或同时性 BM（即 mRCC 诊断后<3 个月）。提取患者人口统计学、BM、系统治疗和结局的详细信息。采用卡方检验、方差分析和 Kaplan-Meier 法进行统计分析，以描述生存结果。
结果
共确定了 74 例患者（40 例 mRCC 诊断后≥3 个月，34 例 mRCC 诊断后<3 个月），其中 72 例（97%）接受了 BM 的局部治疗。异时性 BM 患者的一线治疗中位（四分位距 [IQR]）持续时间为 7.8（3.6-17.0），同时性 BM 患者为 5.1（3.3-12.6）（P=0.6）。在 BM 诊断后，异时性 BM 组继续接受相同的系统治疗，中位（IQR）持续时间为 1.9（0.4-5.5）个月，最常见的改变是由于颅外疾病进展。从 mRCC 诊断开始，异时性 BM 患者的中位（IQR）OS 优于同时性 BM 患者，分别为 64.2（31.4-未达到）和 22.4（9.7-34.1）个月（P=0.003）。然而，这与 BM 诊断时的时间没有显著差异，中位（IQR）生存时间分别为 20.6（9.2-31.2）和 15.7（11.6-未达到）个月（P=0.95）。
结论
mRCC 伴 BM 的患者，无论是异时性还是同时性 BM，其 OS 均延长。对于诊断为异时性 BM 的患者，BM 的发生可能是系统治疗失败的早期迹象。
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