Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium.
Department of Radiology, University Hospitals Leuven, Leuven, Belgium.
Acta Oncol. 2020 Jul;59(7):818-824. doi: 10.1080/0284186X.2020.1750696. Epub 2020 Apr 16.
Metastatic renal cell carcinoma (mRCC) patients with bone metastases (BM) are at high risk for skeletal related events and have a poorer outcome when treated with vascular endothelial growth factor receptor-tyrosine kinase inhibitors (VEGFR-TKIs). Computed tomography (CT) lacks sensitivity to detect BM in mRCC. We aimed to determine the added value of whole body diffusion-weighted magnetic resonance imaging (WB-DWI/MRI) to CT for the detection of BM in mRCC and to estimate the prognostic impact of the number of BM in mRCC patients treated with VEGFR-TKIs. We conducted a prospective study including consecutive mRCC patients treated with a first-line VEGFR-TKI in the metastatic setting. All patients underwent a pretreatment thoracic-abdominal-pelvic CT and WB-DWI/MRI. CT and WB-DWI/MRI were compared for the detection of BM. The number of detected BM was correlated with response rate (RR), progression-free survival (PFS) and overall survival (OS) after start of the VEGFR-TKI. Ninety-two patients were included. BM were found in 55% of the patients by WB-DWI/MRI and in 43% of the patients by CT ( = .003). Mean number of BM discovered per patient was 6.8 by WB-DWI/MRI versus 1.9 by CT ( = .006). The cutoff of ≤5 versus >5 BM on WB-DWI/MRI had the highest discriminative power for all outcome measures. Patients with >5 BM had a lower RR (10% versus 42%), more frequently early progressive disease (43% versus 13%, = .003), shorter PFS (4 versus 10 months, = .006) and shorter OS (10 versus 35 months, < .0001) compared to patients with ≤5 BM. WB-DWI/MRI detects significantly more BM in mRCC patients than CT, allowing better estimation of the prognostic impact of BM in mRCC patients treated with VEGFR-TKIs. The prognostic impact should now be validated in patients treated with immune checkpoint inhibitors.
转移性肾细胞癌（mRCC）伴骨转移（BM）患者发生骨骼相关事件的风险较高，且接受血管内皮生长因子受体酪氨酸激酶抑制剂（VEGFR-TKIs）治疗时预后较差。计算机断层扫描（CT）对 mRCC 中的 BM 检测灵敏度较低。我们旨在确定全身扩散加权磁共振成像（WB-DWI/MRI）对 CT 在 mRCC 中检测 BM 的附加价值，并评估在接受 VEGFR-TKI 治疗的 mRCC 患者中 BM 数量对预后的影响。我们进行了一项前瞻性研究，纳入了转移性环境下接受一线 VEGFR-TKI 治疗的连续 mRCC 患者。所有患者均接受了胸部-腹部-骨盆 CT 和全身 WB-DWI/MRI 预处理。比较了 CT 和 WB-DWI/MRI 对 BM 的检测。所检测的 BM 数量与接受 VEGFR-TKI 治疗后 RR、无进展生存期（PFS）和总生存期（OS）相关。共纳入 92 例患者。WB-DWI/MRI 发现 55%的患者有 BM，而 CT 发现 43%的患者有 BM（ = .003）。每位患者发现的 BM 平均数量为 6.8 个，而 CT 为 1.9 个（ = .006）。WB-DWI/MRI 上 ≤5 与 >5 BM 的截断值对所有预后指标均具有最高的鉴别力。WB-DWI/MRI 上 >5 BM 的患者 RR 较低（10%对 42%），更常出现早期进展性疾病（43%对 13%， = .003），PFS 更短（4 对 10 个月， = .006），OS 更短（10 对 35 个月， < .0001）。WB-DWI/MRI 比 CT 更能检测到 mRCC 患者的 BM，从而更好地评估了接受 VEGFR-TKI 治疗的 mRCC 患者中 BM 对预后的影响。现在应在接受免疫检查点抑制剂治疗的患者中验证该预后影响。
