Alradhi Mohammed, Zhang Zewen, Safi Mohammed, Al-Danakh Abdullah, Aldhbi Mokhtar, Baldi Salim, Kui Li, Alradhi Abdulaziz, Hamri Saeed Bin, Lun Lo Ka, Zhao Yi, Jin Yang
Department of Urology, The Affiliated Hospital of Qingdao Binhai Univesity, Qingdao, China.
Department of Urology, Amran University, Amran, Yemen.
Front Pharmacol. 2023 Jan 4;13:996404. doi: 10.3389/fphar.2022.996404. eCollection 2022.
Patients with metastatic renal cell cancer (mRCC) for whom surgery is ineffective may experience a poor prognosis. The different sites where cancer has spread, and the different ways to treat it in the immune checkpoint inhibitors era could help clinical decision-making. In this study, individuals with mRCC were selected from the SEER database between 2015 and 2016 based on the Food and Drug Administration (FDA) approval of ICIs. A total of 4011 mRCC patients were studied (2239 with lung metastasis vs. 797 with liver metastasis in the immune checkpoint inhibitors period). The age 64 years and male were the majority in all cases of mRCC. When the two groups (lung metastasis and liver metastasis) were compared, the liver metastasis group had more bone metastasis than the lung metastasis group (41.8% vs. 34.1%, < 0.001), but the lung metastasis group had more brain metastasis (8.9% vs. 11.5%) ( = 0.023). In a study of overall survival (OS) in the ICI era for mRCC, we found that lung metastasis was significantly associated with improved survival compared to liver metastasis ( < 0.001: 7 months vs. 4 months). This survival advantage restricted in lung metastasis group of mRCC after adjusting age, sex, race, marital status, histological type, metastasis to bone, and brain, origin, radiotherapy record chemotherapy record, surgery on multivariable using Cox proportional hazard model (HR = 1.407; 95% CI = 1. 269-1.560; < 0.001). The overall survival difference between the variables of the lung metastasis and liver metastasis was noted among most of the variables, with survival benefits restricted to patients in lung metastasis in the ICI era. Patients who had undergone chemotherapy and surgery were strongly positive predictors for better OS (HR = 0.427; 95% CI = 0.379-0.481; < 0.001) (HR = 0.371; 95% CI = 0.311-0.444; =< 0.001), and (HR = 0.313; 95% CI = 0.264-0.372; < 0.001), (HR = 0.427; 95% CI = 0.320-0.568; < 0.001) in lung metastasis group and liver metastasis group. The c-index of the prognostic nomogram for OS prediction was 0.74 and 0.73. This study found that patients with lung metastasis who received ICI had better survival than those with liver metastasis. Chemotherapy and surgery enhanced survival in kidney cancer patients, whereas radiation had little impact. We developed a complete and realistic nomogram for mRCC patients based on distant metastases to the lung and liver.
对于手术无效的转移性肾细胞癌（mRCC）患者，其预后可能较差。在免疫检查点抑制剂时代，癌症扩散的不同部位以及不同的治疗方法有助于临床决策。在本研究中，根据美国食品药品监督管理局（FDA）对免疫检查点抑制剂的批准，于2015年至2016年间从监测、流行病学和最终结果（SEER）数据库中选取mRCC患者。共研究了4011例mRCC患者（免疫检查点抑制剂治疗期间，2239例有肺转移，797例有肝转移）。在所有mRCC病例中，64岁及男性占大多数。比较两组（肺转移和肝转移）时，肝转移组的骨转移比肺转移组更多（41.8%对34.1%，P<0.001），但肺转移组的脑转移更多（8.9%对11.5%）（P=0.023）。在一项关于mRCC免疫检查点抑制剂时代总生存期（OS）的研究中，我们发现与肝转移相比，肺转移与生存期改善显著相关（P<0.001：7个月对4个月）。在使用Cox比例风险模型对年龄、性别、种族、婚姻状况、组织学类型、骨转移和脑转移、原发部位、放疗记录、化疗记录、手术进行多变量调整后，这种生存优势仅限于mRCC的肺转移组（风险比[HR]=1.407；95%置信区间[CI]=1.269 - 1.560；P<0.001）。在大多数变量中都注意到了肺转移和肝转移变量之间的总生存期差异，在免疫检查点抑制剂时代，生存获益仅限于肺转移患者。接受过化疗和手术的患者是更好总生存期的强阳性预测因素（HR=0.427；95%CI=0.379 - 0.481；P<0.001）（HR=0.371；95%CI=0.311 - 0.444；P<0.001），以及（HR=0.313；95%CI=0.264 - 0.372；P<0.001），（HR=0.427；95%CI=0.320 - 0.568；P<0.001），分别在肺转移组和肝转移组中。用于OS预测的预后列线图的c指数为0.74和0.73。本研究发现，接受免疫检查点抑制剂治疗的肺转移患者比肝转移患者生存期更好。化疗和手术可提高肾癌患者的生存率，而放疗影响较小。我们基于肺和肝的远处转移为mRCC患者开发了一个完整且现实的列线图。
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