巴西癌症中心治疗可及性对转移性肾细胞癌患者生存的影响。
Influence of treatment access on survival of metastatic renal cell carcinoma in brazilian cancer center.
机构信息
Departamento de Oncologia Médica, AC Camargo Cancer Center, São Paulo, SP, Brasil.
Department of Medical Oncology and Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA.
出版信息
Int Braz J Urol. 2021 May-Jun;47(3):566-573. doi: 10.1590/S1677-5538.IBJU.2020.0443.
BACKGROUND
Tyrosine kinase inhibitors (TKI) and immunotherapy improved survival in metastatic renal cell carcinoma (mRCC). Disparities in treatment access are present in healthcare systems globally. The aim of this study was to analyze survival outcomes of mRCC patients treated with first-line TKIs in the public (PHS) and private (PrS) health system in a Brazilian Cancer Center.
MATERIALS AND METHODS
Records from all mRCC patients treated with first-line TKIs from 2007-2018 were reviewed retrospectively. Categorial variables were compared by Fisher's exact test. Survival was estimated by Kaplan-Maier method and survival curves were compared using the log-rank test. Prognostic factors were adjusted by Cox regression model.
RESULTS
Of the 171 eligible patients, 37 (21.6%) were PHS patients and 134 (78.4%) were PrS patients. There were no difference in age, gender, or sites of metastasis. PHS patients had worse performance status (ECOG ≥2, 35.1% vs. 13.5%, p=0.007), poorer risk score (IMDC poor risk, 32.4% vs. 16.4%, p=0.09), and less nephrectomies (73% vs. 92.5%, p=0.003) than PrS patients. Median lines of therapy was one for PHS versus two for PrS patients (p=0.03). Median overall survival (OS) was 16.5 versus 26.5 months (p=0.002) and progression-free survival (PFS), 8.4 versus 11 months (p=0.01) for PHS and PrS patients, respectively. After adjusting for known prognostic factors on multivariate analysis, PHS patients still had a higher risk of death (HR: 1.61, 95% CI: 1.01-2.56, p=0.047).
CONCLUSION
Patients with mRCC treated via the PHS had worse overall survival, possibly due to poorer prognosis at presentation and less drug access.
背景
酪氨酸激酶抑制剂（TKI）和免疫疗法改善了转移性肾细胞癌（mRCC）患者的生存。在全球的医疗体系中，治疗机会存在差异。本研究的目的是分析在巴西癌症中心接受一线 TKI 治疗的 mRCC 患者在公共（PHS）和私人（PrS）卫生系统中的生存结果。
材料和方法
回顾性分析了 2007 年至 2018 年期间接受一线 TKI 治疗的所有 mRCC 患者的记录。通过 Fisher 精确检验比较分类变量。通过 Kaplan-Meier 方法估计生存，通过对数秩检验比较生存曲线。通过 Cox 回归模型调整预后因素。
结果
在 171 名符合条件的患者中，37 名（21.6%）为 PHS 患者，134 名（78.4%）为 PrS 患者。两组患者的年龄、性别或转移部位均无差异。PHS 患者的表现状态更差（ECOG≥2，35.1% vs. 13.5%，p=0.007），风险评分更差（IMDC 预后不良，32.4% vs. 16.4%，p=0.09），且接受肾切除术的比例更低（73% vs. 92.5%，p=0.003）。PHS 患者的中位治疗线数为 1 条，而 PrS 患者为 2 条（p=0.03）。PHS 和 PrS 患者的中位总生存期（OS）分别为 16.5 个月和 26.5 个月（p=0.002），无进展生存期（PFS）分别为 8.4 个月和 11 个月（p=0.01）。多因素分析调整已知预后因素后，PHS 患者的死亡风险仍然更高（HR：1.61，95%CI：1.01-2.56，p=0.047）。
结论
接受 PHS 治疗的 mRCC 患者总体生存率较差，可能是由于就诊时的预后较差和药物获取受限。
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