Angulo Javier C, Larrinaga Gorka, Lecumberri David, Iturregui Ane Miren, Solano-Iturri Jon Danel, Lawrie Charles H, Armesto María, Dorado Juan F, Nunes-Xavier Caroline E, Pulido Rafael, Manini Claudia, López José I
Clinical Department, Faculty of Medical Sciences, European University of Madrid, 28905 Getafe, Spain.
Biobizkaia Health Research Institute, 48903 Barakaldo, Spain.
Cancers (Basel). 2024 Aug 7;16(16):2786. doi: 10.3390/cancers16162786.
(1) Objective: To develop a clinically useful nomogram that may provide a more individualized and accurate estimation of cancer-specific survival (CSS) for patients with clear-cell (CC) metastatic renal cell carcinoma (mRCC) treated with nephrectomy and vascular endothelial growth factor receptor-tyrosine kinase inhibitor (VEGFR-TKI)-based sequential therapy. (2) Methods: A prospectively maintained database of 145 patients with mRCC treated between 2008 and 2018 was analyzed to predict the CSS of patients receiving sunitinib and second- and third-line therapies according to current standards of practice. A nomogram based on four independent clinical predictors (Eastern Cooperative Oncology Group status, International Metastatic RCC Database Consortium score, the Morphology, Attenuation, Size and Structure criteria and Response Evaluation Criteria in Solid Tumors response criteria) was calculated. The corresponding 1- to 10-year CSS probabilities were then determined from the nomogram. (3) Results: The median age was 60 years (95% CI 57.9-61.4). The disease was metastatic at diagnosis in 59 (40.7%), and 86 (59.3%) developed metastasis during follow-up. Patients were followed for a median 48 (IQR 72; 95% CI 56-75.7) months after first-line VEGFR-TKI initiation. The concordance probability estimator value for the nomogram is 0.778 ± 0.02 (mean ± SE). (4) Conclusions: A nomogram to predict CSS in patients with CC mRCC that incorporates patient status, clinical risk classification and response criteria to first-line VEGFR-TKI at 3 months is presented. This new tool may be useful to clinicians assessing the risk and prognosis of patients with mRCC.
（1）目的：开发一种临床实用的列线图，可为接受肾切除术和基于血管内皮生长因子受体酪氨酸激酶抑制剂（VEGFR-TKI）的序贯治疗的透明细胞（CC）转移性肾细胞癌（mRCC）患者提供更个体化、准确的癌症特异性生存（CSS）估计。（2）方法：分析2008年至2018年期间接受治疗的145例mRCC患者的前瞻性维护数据库，根据当前实践标准预测接受舒尼替尼及二线和三线治疗患者的CSS。计算基于四个独立临床预测因素（东部肿瘤协作组状态、国际转移性RCC数据库联盟评分、形态学、衰减、大小和结构标准以及实体瘤反应评估标准反应标准）的列线图。然后从列线图中确定相应的1至10年CSS概率。（3）结果：中位年龄为60岁（95%CI 57.9-61.4）。59例（40.7%）在诊断时已有转移，86例（59.3%）在随访期间发生转移。一线VEGFR-TKI开始后，患者的中位随访时间为48（IQR 72；95%CI 56-75.7）个月。列线图的一致性概率估计值为0.778±0.02（均值±标准误）。（4）结论：提出了一种用于预测CC mRCC患者CSS的列线图，该列线图纳入了患者状态、临床风险分类以及3个月时对一线VEGFR-TKI的反应标准。这一新工具可能对临床医生评估mRCC患者的风险和预后有用。
