Ascension Saint Francis Hospital, 355 Ridge Ave, Evanston, IL 60202, USA.
Faith Regional Health Services, 2700 W Norfolk Ave, Norfolk, NE 68701, USA.
Cancer Epidemiol. 2024 Oct;92:102639. doi: 10.1016/j.canep.2024.102639. Epub 2024 Aug 14.
The advent of immune checkpoint inhibitors (ICI) has brought about a significant transformation in the treatment of immunogenic tumors. On November 23, 2015, the United States Food and Drug Administration approved Nivolumab to treat metastatic renal cell carcinoma (RCC). We aimed to assess potential changes in the survival rates of patients with metastatic RCC at a population level after the approval of Nivolumab.
We used data from the latest version of the Surveillance, Epidemiology, and End Results (SEER) database which encompasses data up to the year 2020. We included patients with age ≥ 20 years who were diagnosed with 'distant' RCC from 2011 through 2020. Based on the approval of Nivolumab, the period from 2011 to 2020 was further grouped into 2011-2015 (pre-ICI era) and 2016-2020 (ICI era).
The median overall survival (OS) was 8 months in the pre-ICI era compared to 11 months in the ICI era (log-rank test, χ2 = 102.53, p < 0.001). Patients diagnosed with metastatic RCC in the ICI era had a significantly lower risk of dying [Cox proportional Hazard Ratio of 0.77, 95 % CI (0.74-0.80)] compared to patients diagnosed in the pre-ICI era. Additionally, patients under the age of 75 had a lower risk of death compared to those aged 75 years or older. Patients who received chemotherapy (systemic therapy), radiotherapy, or surgery faced a significantly lower risk of mortality. Individuals with metastasis to the brain, bone, liver, or lung had a significantly higher risk of death than those without metastasis to these locations. Marital status also played a role, as married individuals had a significantly lower risk of death compared to those who were divorced, separated, or widowed at the time of diagnosis. Furthermore, income level influenced survival, with patients earning a median annual household income of more than USD 75,000 exhibiting a significantly lower risk of mortality compared to those earning between USD 50,000 and USD 74,000. There was no significant difference in survival observed between non-Hispanic blacks and non-Hispanic whites.
The advent of immune checkpoint inhibitors has led to a substantial improvement in the median overall survival of individuals diagnosed with metastatic renal cell carcinoma.
免疫检查点抑制剂（ICI）的出现，为免疫原性肿瘤的治疗带来了重大变革。2015 年 11 月 23 日，美国食品和药物管理局（FDA）批准 nivolumab 用于治疗转移性肾细胞癌（RCC）。本研究旨在评估 nivolumab 获批后，人群水平转移性 RCC 患者的生存率是否发生潜在变化。
我们使用了最新版监测、流行病学和最终结果（SEER）数据库的数据，该数据库的数据截止到 2020 年。我们纳入了年龄≥20 岁、2011 年至 2020 年期间诊断为“远处”RCC 的患者。根据 nivolumab 的获批情况，2011 年至 2020 年进一步分为 2011-2015 年（ICI 前时代）和 2016-2020 年（ICI 时代）。
ICI 前时代的中位总生存期（OS）为 8 个月，ICI 时代为 11 个月（对数秩检验，χ2=102.53，p<0.001）。与 ICI 前时代相比，ICI 时代诊断为转移性 RCC 的患者死亡风险显著降低[Cox 比例风险比为 0.77，95%CI（0.74-0.80）]。此外，年龄<75 岁的患者死亡风险低于 75 岁或以上的患者。接受化疗（全身治疗）、放疗或手术的患者死亡风险显著降低。有脑、骨、肝或肺转移的患者死亡风险显著高于无这些部位转移的患者。婚姻状况也有影响，与离婚、分居或丧偶的患者相比，已婚患者死亡风险显著降低。此外，收入水平也影响生存，中位年收入超过 75000 美元的患者死亡风险显著低于年收入在 50000 美元至 74000 美元之间的患者。非西班牙裔黑人和非西班牙裔白人之间的生存差异无统计学意义。
免疫检查点抑制剂的出现，使转移性肾细胞癌患者的中位总生存期显著提高。
