Mani S, Todd M B, Katz K, Poo W J
Yale Comprehensive Cancer Center, New Haven, Connecticut, USA.
J Urol. 1995 Jul;154(1):35-40.
Clinical characteristics prognostic of survival in patients with metastatic renal cell carcinoma treated with biological response modifiers are poorly understood. Understanding these prognostic features may help with better stratification of patients in clinical trials and define further appropriate treatment for each prognostic subgroup.
A retrospective study of 84 patients with recurrent or metastatic renal cancer was conducted to identify prognostic factors for survival in patients who received biological response modifiers (alpha-interferon, beta-interferon, gamma-interferon and interleukin-2).
Univariate analysis identified Eastern Cooperative Oncology Group (ECOG) performance status (1 versus 0, p < 0.001), bone metastasis (p = 0.008), recent weight loss (greater than 10% of total body weight versus no loss, p = 0.028), history of nephrectomy (no versus yes, p = 0.025), recurrence at the renal bed (p = 0.043) and sarcomatoid histology (yes versus no, p < 0.001) as important prognostic indicators. Multivariate analysis of prognostic factors in this patient population indicated that ECOG performance status, sarcomatoid histology and bone metastasis were most significant, while other factors were less significant (p > 0.05) after adjusting for ECOG performance status and sarcomatoid histology. Based on the total positive number of 5 risk factors defined previously the study population separates into 3 risk groups, with a median survival from the low to high risk groups of 14.4, 10.9 and 1.3 months, respectively. Prognostic scores based only on ECOG performance status, sarcomatoid histology and bone metastasis allowed for stratification of our patients into 3 distinct groups with median survivals of 18.6, 8.4 and 3.8 months, which were also predictive of survival (p < 0.05).
Risk factors of ECOG performance status, sarcomatoid histology, bone metastasis, history of nephrectomy, recent weight loss and recurrence at the renal bed are predictive of survival in patients treated with biological response modifiers. In addition to previous findings of prognostic factors in renal cancer patients treated with chemotherapy, we identified sarcomatoid histology as an important risk factor in patients treated with biological response modifiers.
对于接受生物反应调节剂治疗的转移性肾细胞癌患者，其生存预后的临床特征了解甚少。了解这些预后特征可能有助于在临床试验中更好地对患者进行分层，并为每个预后亚组确定进一步合适的治疗方案。
对84例复发性或转移性肾癌患者进行回顾性研究，以确定接受生物反应调节剂（α-干扰素、β-干扰素、γ-干扰素和白细胞介素-2）治疗患者的生存预后因素。
单因素分析确定东部肿瘤协作组（ECOG）体能状态（1级与0级，p<0.001）、骨转移（p=0.008）、近期体重减轻（大于总体重的10%与未减轻，p=0.028）、肾切除术史（无与有，p=0.025）、肾床复发（p=0.043）和肉瘤样组织学（有与无，p<0.001）为重要的预后指标。对该患者群体预后因素的多因素分析表明，ECOG体能状态、肉瘤样组织学和骨转移最为显著，而在调整ECOG体能状态和肉瘤样组织学后，其他因素的显著性较低（p>0.05）。根据先前定义的5个风险因素的总阳性数，研究人群分为3个风险组，低风险组至高风险组的中位生存期分别为14.4个月、10.9个月和1.3个月。仅基于ECOG体能状态、肉瘤样组织学和骨转移的预后评分可将我们的患者分为3个不同的组，中位生存期分别为18.6个月、8.4个月和3.8个月，这也可预测生存情况（p<0.05）。
ECOG体能状态、肉瘤样组织学、骨转移、肾切除术史、近期体重减轻和肾床复发等风险因素可预测接受生物反应调节剂治疗患者的生存情况。除了先前关于接受化疗的肾癌患者预后因素的研究结果外，我们还确定肉瘤样组织学是接受生物反应调节剂治疗患者的一个重要风险因素。
