Department of Urology, Yamagata University Faculty of Medicine, Yamagata, Japan.
Int J Urol. 2020 May;27(5):448-456. doi: 10.1111/iju.14215. Epub 2020 Mar 23.
To create a new model for the prediction of overall survival in synchronous metastatic renal cell carcinoma.
Medical records of 158 patients with metastatic renal cell carcinoma diagnosed at the Yamagata University Hospital from August 2007 to February 2018 were reviewed. Among them, 77 with synchronous metastatic renal cell carcinoma were retrospectively analyzed using the univariate and multivariate analyses. A new prognostic model was constructed, followed by a bootstrap validation to estimate the model fitting. In addition, these prognostic factors were estimated in 67 metachronous metastatic renal cell carcinoma patients.
Five independent prognostic factors were identified in synchronous metastatic renal cell carcinoma: cT3/4, cN1, high corrected calcium, >3.6 neutrophil-to-lymphocyte ratio and central nerve system metastasis. The number (%) and overall survival (95% confidence interval) in the favorable- (0 or 1 risk factor), intermediate- (2 risk factors) and poor-risk (≥3 risk factors) groups were 29 (45.3%) and 67.4 (31.8-NA), 21 (32.8%) and 16.8 (10.0-27.6), and 14 (21.9%) and 9.1 (7.3-13.7) months, respectively. The C-index was 0.72. Patients in the favorable-risk group had better overall survival with nephrectomy than without nephrectomy (hazard ratio 0.29, 95% confidence interval 0.09-0.91 with nephrectomy). In metachronous metastatic renal cell carcinoma, these prognostic factors showed no statistical differences in the overall survival.
Prognostic factors are completely different between synchronous and metachronous metastatic renal cell carcinoma. The new model for synchronous metastatic renal cell carcinoma can predict a good candidate for cytoreductive nephrectomy.
建立一种新的模型以预测同步转移性肾细胞癌的总生存期。
回顾性分析了 2007 年 8 月至 2018 年 2 月在山形大学医院诊断为转移性肾细胞癌的 158 例患者的病历资料。其中，77 例为同步转移性肾细胞癌患者，采用单因素和多因素分析方法对其进行回顾性分析。建立新的预后模型，并通过自举验证来估计模型拟合度。此外，对 67 例异时性转移性肾细胞癌患者的这些预后因素进行了评估。
在同步转移性肾细胞癌中确定了 5 个独立的预后因素：cT3/4、cN1、校正钙升高、中性粒细胞与淋巴细胞比值>3.6 和中枢神经系统转移。在预后良好（0 或 1 个风险因素）、中等（2 个风险因素）和不良（≥3 个风险因素）风险组中，例数（%）和总生存期（95%置信区间）分别为 29（45.3%）和 67.4（31.8-NA）、21（32.8%）和 16.8（10.0-27.6）和 14（21.9%）和 9.1（7.3-13.7）个月。C 指数为 0.72。与未行肾切除术的患者相比，行肾切除术的预后良好风险组患者的总生存期更好（风险比 0.29，95%置信区间 0.09-0.91）。在异时性转移性肾细胞癌中，这些预后因素在总生存期方面没有统计学差异。
同步和异时性转移性肾细胞癌的预后因素完全不同。该同步转移性肾细胞癌的新模型可预测细胞减灭性肾切除术的良好候选者。
