Impact of tyrosine kinase inhibitors on the incidence of brain metastasis in metastatic renal cell carcinoma.
Impact of tyrosine kinase inhibitors on the incidence of brain metastasis in metastatic renal cell carcinoma.
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DOI：
10.1002/cncr.26138
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发表时间：
2011-11-01
期刊：
影响因子：
6.2
通讯作者：
Mahajan A
中科院分区：
文献类型：
--
作者：
Verma J;Jonasch E;Allen P;Tannir N;Mahajan A
本研究旨在评价酪氨酸激酶抑制剂（TKI）对转移性肾细胞癌（mRCC）患者脑转移（脑转移）发生率和总生存期（OS）的影响。所有在2002年至2003年和2006年至2007年期间出现mRCC但无脑转移的患者均使用机构肿瘤登记处进行鉴定。收集以下数据：年龄、性别、Fuhrman分级、疾病部位、肾切除术、全身治疗（包括TKI（索拉非尼或舒尼替尼））、纪念斯隆-凯特琳癌症中心风险类别、脑转移治疗和生命状态。使用考克斯比例风险模型和Kaplan-Meier方法进行统计分析。在确定的338例患者中，154例（46%）在脑转移前接受了TKI治疗，184例（54%）未接受治疗。两组患者在年龄、组织学、肾切除术、肺部以外的病变部位或纪念斯隆-凯特琳癌症中心风险类别方面无显著差异。TKI治疗组的中位OS较长（25个月vs 12.1个月，P < .0001）。在多变量分析中，TKI治疗（风险比[HR]，0.53; 95%置信区间[CI]，0.38-0.74; P < .001）与OS改善相关。44例（13%）患者出现脑转移，其中29例（15.8%）非TKI组和15例（9.7%）TKI组。脑转移的5年准确率分别为40%和17%（P <0.001）。在考克斯多变量分析中，TKI治疗与脑转移发生率较低相关（HR，0.39; 95% CI，0.21-0.73; P = .003）。肺转移增加脑转移的风险（HR，9.61; 95% CI，2.97-31.1; P < .001）。TKI药物治疗可降低mRCC脑转移的发生率。肺转移是脑转移发展的危险因素。
This study was designed to evaluate the impact of tyrosine kinase inhibitors (TKIs) on incidence of brain metastasis (brain metastasis) and overall survival (OS) in patients with metastatic renal cell cancer (mRCC). All patients who presented with mRCC but no brain metastasis in the intervals 2002 to 2003 and 2006 to 2007 were identified using the institutional tumor registry. The following data were collected: age, sex, Fuhrman grade, disease sites, nephrectomy, systemic therapy including TKIs (sorafenib or sunitinib), Memorial Sloan-Kettering Cancer Center risk category, brain metastasis treatment, and vital status. Statistical analysis was performed using the Cox proportional hazards model and the Kaplan-Meier method. Of the 338 patients who were identified; 154 (46%) were treated with a TKI before brain metastasis, and 184 (54%) were not. There were no significant differences in age, histology, nephrectomy, involved sites of disease other than lung, or Memorial Sloan-Kettering Cancer Center risk category between the groups. Median OS was longer in the TKI-treated group (25 months vs 12.1 months, P < .0001). In multivariate analysis, TKI treatment (hazard ratio [HR], 0.53; 95% confidence interval [CI], 0.38–0.74; P < .001) was associated with improved OS. Forty-four (13%) patients developed a brain metastasis, including 29 (15.8%) of the non-TKI group and 15 (9.7%) of the TKI group. The 5-year actuarial rate of brain metastasis was 40% versus 17%, respectively (P < .001). TKI treatment was associated with lower incidence of brain metastasis in Cox multivariate analysis (HR, 0.39; 95% CI, 0.21–0.73; P = .003). Lung metastasis increased the risk of brain metastasis (HR, 9.61; 95% CI, 2.97–31.1; P < .001). Treatment with TKI agents reduces the incidence of brain metastasis in mRCC. Lung metastasis is a risk factor for brain metastasis development.
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