Guida Annalisa, Le Teuff Gwénaël, Alves Carolina, Colomba Emeline, Di Nunno Vincenzo, Derosa Lisa, Flippot Ronan, Escudier Bernard, Albiges Laurence
University of Modena and Reggio Emilia, Modena, Italy.
Department of Medical Oncology, Institute Gustave Roussy, Université Paris-Saclay, Villejuif, France.
Oncotarget. 2020 Dec 8;11(49):4582-4592. doi: 10.18632/oncotarget.27762.
Majority of patients with clear-cell renal cell carcinoma (ccRCC) at first line (1L) treatment are classified in the intermediate-risk (IR) subgroup according to International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) score. As these patients have different prognosis, the aim of this study is to better characterize IR patients in order to better tailor the treatment. Retrospective analysis was performed from IGReCC (Institut Gustave Roussy Renal Cell Carcinoma) database. Overall survival (OS) was defined from start of 1L therapy to death or last follow-up. A multivariable Cox model with backward selection procedure (α = 0.01) and a Classification and Regression Tree (CART) analysis were performed to identify which prognostic factors were associated to OS in IR patients. From 2005 to 2017, 777 patients with ccRCC were treated with an anti-VEGF 1L therapy. Among 571 evaluable patients for IMDC score, 290 (51%) were classified as IR. With median follow-up 5.8 years (min: 0, max: 12.4) 212 deaths (73%) were observed and median OS was 25 months. Only platelet count was significantly associated to OS (hazard ratio 1.88 [95% CI 1.27-2.88] = 0.0017). Median OS for patients with PLT > UNL was 18 months [95% CI 12-23] versus 29 months [95% CI 21.4-35.7] for patients with normal PLT count. The selection of PLT count was confirmed on bootstrap samples and was also selected for the first split of the CART-tree analysis. Patients in the IR group have a heterogeneous prognosis. Elevated PLT count seems identifies a subgroup of patients with poor outcome in the IMDC intermediate-risk population with ccRCC.
大多数一线（1L）治疗的透明细胞肾细胞癌（ccRCC）患者根据国际转移性肾细胞癌数据库联盟（IMDC）评分被归类为中危（IR）亚组。由于这些患者的预后不同，本研究的目的是更好地描述IR患者的特征，以便更好地调整治疗方案。我们对古斯塔夫·鲁西研究所肾细胞癌（IGReCC）数据库进行了回顾性分析。总生存期（OS）定义为从1L治疗开始至死亡或最后一次随访。我们进行了带有向后选择程序（α = 0.01）的多变量Cox模型和分类回归树（CART）分析，以确定哪些预后因素与IR患者的OS相关。2005年至2017年期间，777例ccRCC患者接受了抗VEGF 1L治疗。在571例可评估IMDC评分的患者中，290例（51%）被归类为IR。中位随访5.8年（最小值：0，最大值：12.4），观察到212例死亡（73%），中位OS为25个月。只有血小板计数与OS显著相关（风险比1.88 [95%置信区间1.27 - 2.88] = 0.0017）。血小板计数高于正常上限（UNL）的患者中位OS为18个月[95%置信区间12 - 23]，而血小板计数正常的患者为29个月[95%置信区间21.4 - 35.7]。血小板计数的选择在自抽样样本中得到了证实，并且也被选用于CART树分析的第一次分割。IR组患者的预后存在异质性。血小板计数升高似乎在IMDC中危的ccRCC人群中识别出了一组预后不良的患者亚组。
