Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Int J Urol. 2022 Mar;29(3):212-220. doi: 10.1111/iju.14751. Epub 2021 Nov 30.
Metastatic renal cell carcinoma can occur synchronously or metachronously. We characterized the time from diagnosis to systematic therapy as a categorical variable to analyze its effect on the overall survival and first-line treatment efficacy of metastatic renal cell carcinoma patients.
We initially enrolled 949 consecutive metastatic renal cell carcinoma patients treated with targeted therapies retrospectively from December 2005 to December 2019. X-tile analysis was used to determine cut-off values of time from diagnosis to systematic therapy referring to overall survival. Patients were divided into different groups based on the time from diagnosis to systematic therapy and then analyzed for survival.
Of 358 eligible patients with metastatic renal cell carcinoma, 125 (34.9%) had synchronous metastases followed by cytoreductive nephrectomy, and 233 (65.1%) had metachronous metastases. A total of 28 patients received complete metastasectomy. Three optimal cut-off values for the time from diagnosis to systematic therapy (months) - 1.1, 7.0 and 35.9 - were applied to divide the population into four groups: the synchro group (time from diagnosis to systematic therapy ≤1.0), early group (1.0 < time from diagnosis to systematic therapy ≤ 7.0), intermediate group (7.0 < time from diagnosis to systematic therapy < 36.0) and late group (time from diagnosis to systematic therapy ≥36.0). The targeted therapy-related overall survival (P < 0.001) and progression-free survival (P < 0.001) values were significantly different among the four groups. Patients with longer time from diagnosis to systematic therapy had better prognoses and promising efficacy of targeted therapy. With the prolongation of time from diagnosis to systematic therapy, complete metastasectomy was more likely to achieve and bring a better prognosis.
The time from diagnosis to systematic therapy impacts the survival of metastatic renal cell carcinoma patients treated with targeted therapy. The cutoff points of 1, 7 and 36 months were statistically significant. The statistical boundaries might be valuable in future model establishment.
转移性肾细胞癌可同时或异时发生。我们将诊断至系统性治疗的时间描述为分类变量，以分析其对转移性肾细胞癌患者总生存和一线治疗疗效的影响。
我们回顾性纳入了 2005 年 12 月至 2019 年 12 月期间接受靶向治疗的 949 例转移性肾细胞癌患者。采用 X-tile 分析确定参考总生存的诊断至系统性治疗时间的截断值。根据诊断至系统性治疗的时间将患者分为不同组，然后分析生存情况。
358 例符合条件的转移性肾细胞癌患者中，125 例（34.9%）为同步转移，随后接受了肾细胞减瘤切除术，233 例（65.1%）为异时转移。共 28 例患者接受了完全转移灶切除术。诊断至系统性治疗时间（月）的 3 个最佳截断值（1.1、7.0 和 35.9）用于将人群分为 4 组：同步组（诊断至系统性治疗时间≤1.0）、早期组（1.0<诊断至系统性治疗时间≤7.0）、中期组（7.0<诊断至系统性治疗时间<36.0）和晚期组（诊断至系统性治疗时间≥36.0）。4 组之间的靶向治疗相关总生存（P<0.001）和无进展生存（P<0.001）差异有统计学意义。诊断至系统性治疗时间较长的患者预后较好，靶向治疗效果较好。随着诊断至系统性治疗时间的延长，完全转移灶切除术更有可能实现，并带来更好的预后。
诊断至系统性治疗的时间影响接受靶向治疗的转移性肾细胞癌患者的生存。1、7 和 36 个月的截止点具有统计学意义。这些统计界限在未来的模型建立中可能具有价值。
