Tartu University Hospital, Clinic of Hematology & Oncology, Puusepa 8, Tartu, Estonia.
University of Tartu, Clinic of Hematology & Oncology, Tartu, Estonia.
BMC Cancer. 2020 Mar 12;20(1):201. doi: 10.1186/s12885-020-6685-y.
Before the era of targeted therapies, cytokines were the main therapy for metastatic renal cell carcinoma (mRCC). Our aim was to analyze the changes in treatments and overall survival (OS) of all mRCC patients in Estonia in relation to the introduction of new medications.
All patients with mRCC who started medical therapy in Estonia during the years 2004-2012 were identified using the database of the Estonian Health Insurance Fund. Tumor and treatment data were gathered from medical records. Vital status data were obtained from the Estonian Population Registry. The only available therapy before 2008 was interferon alpha-2A (INFa2A), targeted agents added from 2008. For survival analysis, patients were divided into 2 groups: INFa therapy only (group 1) and INFa followed by targeted agents or targeted agents therapy only (group 2).
Out of 416 identified patients, 380 were eligible for analysis. The most common 1st-line treatments were INFa (55%), sunitinib (32%) and INFa+bevacizumab (13%). 28% of patients received 2nd-line therapies and 15% 3rd-line treatments. Median survival of all patients was 13.7 months [95% confidence interval (CI) 11.3-16.2]; 7.6 months (CI 6.4-8.6) for group 1 and 19.8 months (CI 15.6-22.9) for group 2. In multivariate analysis, group 1 had nearly four times higher risk of dying than group 2 [hazard ration (HR) 3.88, 95% CI 2.64-5.72].
The implementation of targeted therapies significantly changed the outcomes of mRCC in Estonia: it prolonged median survival, reduced the risk of death and also enlarged the proportion of patients who received medical therapy.
在靶向治疗时代之前，细胞因子是转移性肾细胞癌（mRCC）的主要治疗方法。我们的目的是分析爱沙尼亚所有 mRCC 患者在引入新药物方面的治疗方法和总生存期（OS）变化。
使用爱沙尼亚健康保险基金数据库确定 2004-2012 年期间在爱沙尼亚开始接受医学治疗的所有 mRCC 患者。从病历中收集肿瘤和治疗数据。从爱沙尼亚人口登记处获得生存状态数据。2008 年前唯一可用的治疗方法是干扰素 alpha-2A（INFa2A），从 2008 年开始添加靶向药物。为了生存分析，将患者分为 2 组：仅 INFa 治疗组（第 1 组）和 INFa 后加用靶向药物或仅靶向药物治疗组（第 2 组）。
在确定的 416 名患者中，有 380 名符合分析条件。最常见的一线治疗方法是 INFa（55%）、舒尼替尼（32%）和 INFa+bevacizumab（13%）。28%的患者接受二线治疗，15%的患者接受三线治疗。所有患者的中位生存期为 13.7 个月[95%置信区间（CI）11.3-16.2]；第 1 组为 7.6 个月（CI 6.4-8.6），第 2 组为 19.8 个月（CI 15.6-22.9）。多变量分析显示，第 1 组的死亡风险比第 2 组高近四倍[风险比（HR）3.88，95%CI 2.64-5.72]。
靶向治疗的实施显著改变了爱沙尼亚 mRCC 的结局：延长了中位生存期，降低了死亡风险，也增加了接受治疗的患者比例。
