Survival and prognostic stratification of 670 patients with advanced renal cell carcinoma
Survival and prognostic stratification of 670 patients with advanced renal cell carcinoma
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DOI：
10.1200/jco.1999.17.8.2530
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发表时间：
1999-08-01
影响因子：
45.3
通讯作者：
Ferrara, J
中科院分区：
文献类型：
--
作者：
Motzer, RJ;Mazumdar, M;Ferrara, J
目的：探讨转移性肾细胞癌(RCC)患者的预后因素及预后预测模型。患者与方法：对1975-1996年间参加纪念斯隆-凯特琳癌症中心24项临床试验的670例晚期RCC患者的治疗前临床特征与生存的关系进行研究。首先对临床特征进行单变量检查。采用基于COX比例风险回归的逐步建模法建立多元模型。结果：中位生存期为10个月(95%可信区间，9~11个月)。670名患者中有57名仍然活着，幸存者的中位随访时间为33个月。在多变量分析中，与较短生存期相关的治疗特征是低卡诺夫斯基状态(正常上肢1.5里姆)，低血红蛋白(正常下限)，高“校正”血钙(>；10 mg/dL)，以及没有接受过肾切除术。这些被用作危险因素，将患者分为三个不同的组。在无风险因素(有利风险)的患者中，25%的患者的中位死亡时间为20个月。53%的患者有一个或两个危险因素(中等风险)，这组患者的中位生存期为10个月。具有3个或3个以上危险因素的患者中位生存期为4个月，占22%。结论：确定了5个预测生存的预后因素，并将转移性肾癌患者分为3个风险组，中位生存期相差6个月或更长。这些风险类别可用于临床试验设计和解释以及患者管理。较低的长期存活率强调了临床研究的优先事项，以确定更有效的治疗方法。(C)1999年，由美国临床肿瘤学会主办。
purpose: To identify prognostic factors and a model predictive for survival in patients with metastatic renal-cell carcinoma (RCC).Patients and Methods: The relationship between pretreatment clinical features and survival was studied in 670 patients with advanced RCC treated in 24 Memorial Sloan-Kettering Cancer Center clinical trials between 1975 and 1996. Clinical features were first examined univariately. A stepwise modeling approach based on Cox proportional hazards regression wets then used to form a multivariate model. The predictive performance of the model was internally validated through a two-step nonparametric bootstrapping process.Results: The median survival time was 10 months (95% confidence interval [CI], 9 to 11 months). Fifty-seven of 670 patients remain alive, and the median follow-up time for survivors was 33 months. Pretreatment features associated with a shorter survival in the multivariate analysis were low Karnofsky performance status ( 1.5 rimes upper limb of normal), low hemoglobin (< lower limit of normal), high "corrected" serum calcium (> 10 mg/dL), and absence of prior nephrectomy. These were used as risk factors to categorize patients into three different groups. The median time to death in the 25% of patients with zero risk factors (favorable-risk) wets 20 months. Fifty-three percent of the patients had one or two risk factors (intermediate-risk), and the median survival time in this group was 10 months. patients with three or more risk factors (poor-risk), who comprised 22% of the patients, had a median survival time of 4 months.Conclusions: Five prognostic factors for predicting survival were identified and used to categorize patients with metastatic RCC into three risk groups, for which the median survival times were separated by 6 months or more. These risk categories can be used in clinical trial design and interpretation and in patient management. The low long-term survival rate emphasizes the priority of clinical investigation to identify more effective therapy. (C) 1999 by American Society of Clinical Oncology.