Deng Ruiyi, Qiu Jianhui, Shang Jiaheng, Yu Chaojian, Tian Peidong, Zhao Zihou, Cai Lin, Zhou Jingcheng, Gong Kan
Department of Urology, Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China.
Institute of Urology, Peking University, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China.
Clin Exp Med. 2024 Dec 21;25(1):20. doi: 10.1007/s10238-024-01535-5.
Sporadic bilateral renal cell carcinoma (BRCC) is a rare situation of RCC. The treatment for BRCC is controversial and there is a lack of authoritative guidelines about the management of BRCC. Patients diagnosed with sporadic BRCC between 2004 and 2020 were identified from Surveillance, Epidemiology, and End Results (SEER) database. The primary outcome was overall survival (OS). Kaplan-Meier survival analysis, Cox regression analysis, and competing risk regression models were used to compare survival outcomes and identify prognostic factors. A total of 20,523 patients (16,534 unilateral RCC [URCC] patients and 3989 BRCC patients) were included. The prognosis of BRCC patients is between metastatic and non-metastatic URCC patients. 3677 patients were diagnosed with localized BRCC (2180 synchronous BRCC patients and 1497 metachronous BRCC patients). Compared with metachronous BRCC, synchronous BRCC patients had relatively poor OS. However, the CSS was similar. Partial nephrectomy (PN) leads to the best OS and provides equivalent oncological outcomes to radical nephrectomy. Local tumor destruction (LTD) could also achieve an acceptable cancer-control effect. Then we developed treatment flowchart for localized BRCC patients. Additionally, we identified the prognostic factors, and analyzed the association between factors using the multivariable Cox regression method. PN should be the initial treatment for sporadic localized BRCC patients if feasible. LTD could be considered as an effective treatment alternative. This study could provide evidence for the optimization of individualized treatment for sporadic BRCC patients.Trial registration: The trial was registered on the ClinicalTrials.gov (NCT06369519).
散发性双侧肾细胞癌（BRCC）是肾细胞癌（RCC）的一种罕见情况。BRCC的治疗存在争议，并且缺乏关于BRCC管理的权威指南。从监测、流行病学和最终结果（SEER）数据库中识别出2004年至2020年间被诊断为散发性BRCC的患者。主要结局是总生存期（OS）。采用Kaplan-Meier生存分析、Cox回归分析和竞争风险回归模型来比较生存结局并确定预后因素。共纳入20523例患者（16534例单侧RCC[URCC]患者和3989例BRCC患者）。BRCC患者的预后介于转移性和非转移性URCC患者之间。3677例患者被诊断为局限性BRCC（2180例同步性BRCC患者和1497例异时性BRCC患者）。与异时性BRCC相比，同步性BRCC患者的OS相对较差。然而，癌症特异性生存期（CSS）相似。部分肾切除术（PN）可带来最佳的OS，并且在肿瘤学结局方面与根治性肾切除术相当。局部肿瘤毁损术（LTD）也可实现可接受的癌症控制效果。然后我们为局限性BRCC患者制定了治疗流程图。此外，我们确定了预后因素，并使用多变量Cox回归方法分析了因素之间的关联。如果可行，PN应作为散发性局限性BRCC患者的初始治疗方法。LTD可被视为一种有效的替代治疗方法。本研究可为散发性BRCC患者个体化治疗的优化提供证据。试验注册：该试验已在ClinicalTrials.gov上注册（NCT06369519）。
