Servicio de Urología, Hospital Pasteur, Montevideo, Uruguay.
Hospital São Lucas da PUCRS, Porto Alegre, Brazil.
JCO Glob Oncol. 2021 May;7:671-685. doi: 10.1200/GO.20.00621.
To assess the effect of clinical and pathological variables on cancer-specific and overall survival (OS) in de novo metastatic patients from a collaborative of primarily Latin American countries.
Of 4,060 patients with renal cell carcinoma diagnosed between 1990 and 2015, a total of 530 (14.5%) had metastasis at clinical presentation. Relationships between clinical and pathological parameters and treatment-related outcomes were analyzed by Cox regression and the log-rank method.
Of 530 patients, 184 (90.6%) had died of renal cell carcinoma. The median OS of the entire cohort was 24 months. American Society of Anesthesiology classification 3-4 (hazard ratio [HR]: 1.64), perirenal fat invasion (HR: 2.02), and ≥ 2 metastatic organ sites (HR: 2.19) were independent prognostic factors for 5-year OS in multivariable analyses. We created a risk group stratification with these variables: no adverse risk factors (favorable group), median OS not reached; one adverse factor (intermediate group), median OS 33 months (HR: 2.04); and two or three adverse factors (poor risk group), median OS 14 months (HR: 3.58).
Our study defines novel prognostic factors that are relevant to a Latin American cohort. With external validation, these easily discerned clinical variables can be used to offer prognostic information across low- and middle-income countries.
评估临床和病理变量对主要来自拉丁美洲国家合作组中初诊转移性患者的癌症特异性和总生存（OS）的影响。
在 1990 年至 2015 年间诊断为肾细胞癌的 4060 例患者中，共有 530 例（14.5%）在临床就诊时发生转移。通过 Cox 回归和对数秩检验分析了临床和病理参数与治疗相关结局之间的关系。
在 530 例患者中，有 184 例（90.6%）死于肾细胞癌。全队列的中位 OS 为 24 个月。美国麻醉医师协会（ASA）分级 3-4 级（风险比 [HR]：1.64）、肾周脂肪侵犯（HR：2.02）和≥2 个转移器官部位（HR：2.19）是多变量分析中 5 年 OS 的独立预后因素。我们根据这些变量创建了风险分组分层：无不良危险因素（有利组），中位 OS 未达到；存在一个不良因素（中间组），中位 OS 33 个月（HR：2.04）；存在两个或三个不良因素（不良风险组），中位 OS 14 个月（HR：3.58）。
我们的研究定义了与拉丁美洲队列相关的新的预后因素。通过外部验证，这些易于识别的临床变量可用于提供中低收入国家的预后信息。
