Hypertension as predictor of sunitinib treatment outcome in metastatic renal cell carcinoma
Hypertension as predictor of sunitinib treatment outcome in metastatic renal cell carcinoma
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DOI：
10.3109/0284186x.2010.543696
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发表时间：
2011-05-01
期刊：
影响因子：
3.1
通讯作者：
Joensuu, Heikki
中科院分区：
文献类型：
--
作者：
Bono, Petri;Rautiola, Juhana;Joensuu, Heikki
高血压和甲状腺功能减退症是VEGFR抑制剂常见的副作用。我们调查了在舒尼替尼治疗期间诊断出的高血压或甲状腺功能减退症是否与治疗效果有关。材料和方法。连续64例转移性肾细胞癌(RCC)患者在一个中心接受舒尼替尼治疗。高血压被定义为持续性血压&150/100毫米汞柱或需要加强现有抗高血压药物的血压。甲状旁腺功能减退被定义为促甲状腺激素水平升高和需要激素替代治疗的临床症状(>；=Gr。II甲状旁腺激素)。结果。24例(38%)患者出现高血压，12例(19%)患者出现甲状腺功能减退。给予舒尼替尼的剂量与高血压或甲状腺功能减退症没有明显关系。高血压与甲状腺功能减退症之间无相关性。高血压与肿瘤对舒尼替尼的反应频繁、病情进展时间长和总生存期长有关(p分别为0.001、0.0003和0.001)。在多变量分析中，高血压是无进展生存的独立预测因素(风险比，0.21；95%可信区间0.076至0.59，p=0.0030)。在有或没有高血压的患者中，>；=3级不良事件的发生率在统计学上没有显著差异。结论。舒尼替尼相关性高血压可能是转移性肾癌治疗效果的有力预测标记物。
Hypertension and hypothyreoidism are frequent side effects of VEGFR-inhibitors. We investigated whether hypertension or hypothyreoidism diagnosed during sunitinib treatment is associated with treatment efficacy. Material and methods. Sixty-four consecutive patients with metastatic renal cell cancer (RCC) were treated with sunitinib in a single center. Hypertension was defined as persistent blood pressure > 150/100 mmHg or blood pressure requiring intensification of pre-existing anti-hypertensive medication. Hypothyreoidism was defined as elevation of TSH levels and clinical symptoms requiring hormone replacement therapy (>= Gr. II hypothyreoidim). Results. Twenty-four (38%) patients developed hypertension and 12 (19%) hypothyreoidism. The dose of sunitinib administered was not significantly associated with hypertension or hypothyreoidism. There was no correlation between hypertension and hypothyreoidism. Hypertension was associated with frequent tumor response to sunitinib, a long time to disease progression and long overall survival (p = 0.001, 0.0003 and 0.001, respectively). In a multivariate analysis, hypertension was an independent predictor of progression-free survival (hazard ratio, 0.21; 95% CI 0.076 to 0.59, p = 0.0030). There were no statistically significant differences in the frequency of >= grade 3 adverse events between patients with or without hypertension. Conclusion. Sunitinib-associated hypertension may be a strong predictive marker for treatment efficacy in metastatic RCC.