Department of Urology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Department of Surgical Oncology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Cancer Med. 2021 Nov;10(21):7492-7502. doi: 10.1002/cam4.4270. Epub 2021 Sep 12.
Cytoreductive surgery is one of the recommended treatments for metastatic renal cell carcinoma, while the prognostic information of these patients treated with cytoreductive surgery is limited. In this study, we aimed to investigate the survival profiles based on conditional survival (CS) estimates in metastatic clear cell renal cell carcinoma (mccRCC) patients treated with cytoreductive surgery of primary tumor.
We identified and extracted mccRCC patients from the Surveillance, Epidemiology, and End Results database. We used Kaplan-Meier method to perform CS analyses. A multivariate Cox regression model was applied to explore the changes of well-known prognostic factors.
Conditional overall survival (COS) and conditional cancer-specific survival (CCSS) improved increasingly at all periods of survivorships compared to survival estimates at baseline in overall population of mccRCC. The 36-month COS improved by 3.3%-6.4% given per 12 additional months of survivorships and the CCSS improved significantly from 45.1% (95% CI 42.8-47.3) at 12 months to 67.1% (95% CI 62.0-71.7) at 60 months. Much more survival gain was observed in patients with advanced disease. Furthermore, the prognostic significance of age and pathological factors diminished and even disappeared in a long-term survivorship.
Conditional overall survival and CCSS improved with time dynamically in mccRCC patients treated with cytoreductive surgery of primary tumor. Patients with advanced disease achieved significant survival gain and even could harvest a better prognosis given that the time of survivorship exceeds a certain period. Our findings could provide valuable and practical data for patient counseling and surveillance strategy making.
细胞减灭术是转移性肾细胞癌的推荐治疗方法之一，而接受细胞减灭术治疗的这些患者的预后信息有限。在这项研究中，我们旨在研究基于条件生存（CS）估计的转移性透明细胞肾细胞癌（mccRCC）患者接受原发肿瘤细胞减灭术后的生存特征。
我们从监测、流行病学和最终结果数据库中确定并提取了 mccRCC 患者。我们使用 Kaplan-Meier 方法进行 CS 分析。应用多变量 Cox 回归模型探讨了已知预后因素的变化。
与总体人群的基线生存估计相比，条件总生存（COS）和条件癌症特异性生存（CCSS）在所有生存随访期内均逐渐提高。每增加 12 个月的生存随访，36 个月的 COS 提高了 3.3%-6.4%，CCSS 从 12 个月时的 45.1%（95%CI 42.8-47.3）显著提高到 60 个月时的 67.1%（95%CI 62.0-71.7）。晚期疾病患者的生存获益更大。此外，年龄和病理因素的预后意义在长期生存随访中减弱甚至消失。
接受原发肿瘤细胞减灭术的 mccRCC 患者的条件总生存和 CCSS 随时间动态改善。晚期疾病患者获得了显著的生存获益，甚至可以在生存随访时间超过一定时间后获得更好的预后。我们的研究结果可为患者咨询和监测策略制定提供有价值和实用的数据。
