Dong Yi, Wang Zheng, Lu Xin, Wu Zhenjie, Zhang Zongqin, Yu Yongwei, Peng Fei, Liu Bing, Wang Linhui
Department of Urology, Changzheng Hospital, Naval Medical University, Shanghai, China.
Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China.
Cancer. 2020 May 1;126 Suppl 9:2079-2085. doi: 10.1002/cncr.32800.
The effectiveness of local surgery for bone metastases (BM) arising from renal cell carcinoma (RCC) remains uncertain. Herein, the authors performed what to the best of their knowledge is the first investigation of the outcomes of Chinese patients with RCC and BM.
Data were collected for 168 patients with RCC and BM who were treated at Changzheng Hospital in Shanghai, China, between March 2009 and December 2018. All patients underwent local surgery for BM arising from RCC. Overall survival (OS) was defined as the interval between the date of local surgery and death or last follow-up and was estimated using the Kaplan-Meier method. Univariate and multivariable Cox proportional hazards analyses were used to identify significant prognostic factors.
The median OS in the study cohort was 43 months (range, 0-113 months). The 1-year, 3-year, and 5-year survival rates after surgery were 77.4%, 55.9%, and 31.8%, respectively. Univariate analyses demonstrated significant survival differences associated with sex (P = .003), the number of preoperative metastatic sites (BM alone or BM with concomitant metastasis; P < .001), and the number of BM (single or multiple; P = .008). OS also did not appear to differ regardless of whether the patients received postsurgical targeted therapy. Multivariable Cox regression demonstrated that the following characteristics were independent predictors of OS: the number of preoperative metastatic sites, International Metastatic Renal Cell Carcinoma Database Consortium risk score, and Memorial Sloan Kettering Cancer Center score.
Careful patient selection for local surgery is of paramount importance. The prognoses of patients in the Memorial Sloan Kettering Cancer Center-based and International Metastatic Renal Cell Carcinoma Database Consortium-based poor-risk groups were much worse than those of the intermediate-risk groups. In current clinical practice, "stratified treatment" can be performed according to these criteria.
肾细胞癌（RCC）骨转移（BM）的局部手术疗效仍不确定。在此，作者进行了据他们所知首次关于中国RCC合并BM患者结局的研究。
收集了2009年3月至2018年12月在中国上海长征医院接受治疗的168例RCC合并BM患者的数据。所有患者均接受了针对RCC骨转移的局部手术。总生存期（OS）定义为局部手术日期至死亡或最后一次随访的时间间隔，并采用Kaplan-Meier法进行估计。单因素和多因素Cox比例风险分析用于确定显著的预后因素。
研究队列的中位OS为43个月（范围0至113个月）。术后1年、3年和5年生存率分别为77.4%、55.9%和31.8%。单因素分析显示，性别（P = 0.003）、术前转移部位数量（单纯骨转移或合并其他转移；P < 0.001）以及骨转移数量（单个或多个；P = 0.008）与生存存在显著差异。无论患者术后是否接受靶向治疗，OS似乎也无差异。多因素Cox回归显示，以下特征是OS的独立预测因素：术前转移部位数量、国际转移性肾细胞癌数据库联盟风险评分和纪念斯隆凯特琳癌症中心评分。
仔细选择局部手术患者至关重要。基于纪念斯隆凯特琳癌症中心和国际转移性肾细胞癌数据库联盟的低风险组患者的预后比中风险组差得多。在当前临床实践中，可根据这些标准进行“分层治疗”。
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