Department of Urology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
Department of Urology, Tokyo Women's Medical University Medical Center East, 2-1-10 Nishiogu, Arakawa-ku, Tokyo, 116-8567, Japan.
Clin Exp Nephrol. 2021 Jun;25(6):674-682. doi: 10.1007/s10157-021-02038-3. Epub 2021 Feb 27.
The data regarding oncological outcome in advanced renal cell carcinoma (RCC) arising in end-stage renal disease (ESRD) are limited.
Patients diagnosed with advanced RCC on maintenance dialysis therapy (ESRD-RCC) and treated with tyrosine kinase inhibitors (TKIs) were retrospectively evaluated. Progression-free survival (PFS), overall survival (OS), and objective response rate (ORR) after initiation of first-line TKI therapy in ESRD-RCC patients were compared to those in RCC arising in the general population (sporadic RCC).
A total of 36 and 240 patients were diagnosed with advanced ESRD-RCC and sporadic RCC, respectively. PFS and OS were significantly shorter in patients with ESRD-RCC than in those with sporadic RCC (p = 0.0004 and p = 0.0045). After adjusting for histopathological type, MSKCC risk and liver metastasis status, ESRD status (ESRD-RCC vs. sporadic RCC) was not an independent risk factor for PFS or OS (both, p > 0.05). The ORR tended to be lower in patients with ESRD-RCC than in those with sporadic RCC (11% vs. 28%, p = 0.0833). In 34 patients with ESRD-RCC treated with sorafenib, longer duration of dialysis was an independent prognostic factor for shorter OS (hazard ratio 3.21, p = 0.0370).
Outcome of advanced ESRD-RCC was poorer than that of sporadic RCC, but this finding was affected by other prognostic factors. Nevertheless, the study suggested that advanced ESRD-RCC was not an indolent disease. Additionally, patients with a longer duration of dialysis therapy might require careful monitoring.
关于终末期肾病（ESRD）中发生的晚期肾细胞癌（RCC）的肿瘤学结果的数据有限。
回顾性评估了在维持性透析治疗（ESRD-RCC）中诊断为晚期 RCC 并接受酪氨酸激酶抑制剂（TKI）治疗的患者。在 ESRD-RCC 患者中，一线 TKI 治疗开始后的无进展生存期（PFS）、总生存期（OS）和客观缓解率（ORR）与在普通人群（散发性 RCC）中发生的 RCC 进行了比较。
共有 36 例和 240 例患者被诊断为晚期 ESRD-RCC 和散发性 RCC。与散发性 RCC 患者相比，ESRD-RCC 患者的 PFS 和 OS 明显更短（p=0.0004 和 p=0.0045）。在校正了组织病理学类型、MSKCC 风险和肝转移状态后，ESRD 状态（ESRD-RCC 与散发性 RCC）并不是 PFS 或 OS 的独立危险因素（均 p>0.05）。与散发性 RCC 患者相比，ESRD-RCC 患者的 ORR 倾向于更低（11%比 28%，p=0.0833）。在 34 例接受索拉非尼治疗的 ESRD-RCC 患者中，透析时间较长是 OS 较短的独立预后因素（风险比 3.21，p=0.0370）。
晚期 ESRD-RCC 的预后比散发性 RCC 差，但这一发现受到其他预后因素的影响。尽管如此，该研究表明晚期 ESRD-RCC 并不是一种惰性疾病。此外，透析治疗时间较长的患者可能需要密切监测。
