Prognostic factors in renal cell carcinoma: Association of preoperative sodium concentration with survival
Prognostic factors in renal cell carcinoma: Association of preoperative sodium concentration with survival
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DOI：
10.1158/1078-0432.ccr-07-1721
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发表时间：
2008-03-15
影响因子：
11.5
通讯作者：
Banks, Rosamonde E.
中科院分区：
文献类型：
--
作者：
Vasudev, Naveen S.;Brown, Janet E.;Banks, Rosamonde E.
目的：传统肾细胞癌（RCC）具有可变的自然史，确定个体预后对于指导治疗非常重要。我们检查了肾细胞癌患者中大量血液学和生化变量以及传统肿瘤相关因素的预后意义。实验设计：邀请1998年9月至2005年3月期间因新诊断肾细胞癌而接受肾切除术的患者参加。记录每个病例的临床、病理和实验室数据，并对一部分患者进行免疫表型分析。对患有 N0M0 疾病的患者进行了计划的子集分析。结果：212 名 RCC 患者构成了研究人群。除了肿瘤相关因素外，多变量分析显示，当被视为连续变量且二分至高于和低于中位值时，术前血清钠浓度与总生存期和无病生存期独立且显着相关[139 mmol/L；参考范围135-145 mmol/L，风险比0.44，95%置信区间（95% CI）0.22-0.88，P = 0.014]。高于和低于中位血清钠的患者的五年总生存率估计分别为 67.6% (95% CI 54.2-80.9) 和 44.3% (95% CI 32.8-55.8)。这些结果在 N0M0 亚组分析中得到了延续。 结论：我们已经证实了传统肿瘤相关因素的预后价值，但据我们所知，这些是第一个数据表明术前低钠浓度可能是与 RCC 患者生存率降低相关的重要因素，这表明在 RCC 生存建模中应将血清钠与已确定的预后变量一起考虑。
Purpose: Conventional renal cell carcinoma (RCC) has a variable natural history, and determining individual prognosis is important to guide management. We have examined the prognostic significance of a large number of hematologic and biochemical variables, as well as traditional tumor-related factors in patients with RCC.Experimental Design: Patients undergoing nephrectomy for newly diagnosed RCC between September 1998 and March 2005 were invited to participate. Clinical, pathologic, and laboratory data were recorded in each case, and immunophenotyping was carried out on a subset of patients. A planned subset analysis of patients presenting with N0M0 disease was done.Results: Two hundred twelve patients with RCC formed the study population. In addition to tumor-related factors, multivariate analyses revealed preoperative serum sodium concentration to be independently and significantly associated with overall survival and disease-free survival when considered as both a continuous variable and when dichotomized to above and below the median value [139 mmol/L; reference range 135-145 mmol/L, hazard ratio 0.44, 95% confidence interval (95% CI) 0.22-0.88, P = 0.014]. Five-year overall survival estimates for patients above and below the median serum sodium were 67.6% (95% CI 54.2-80.9) and 44.3% (95% Cl 32.8-55.8), respectively. These findings persisted in the N0M0 subgroup analysis.Conclusions: We have confirmed the prognostic value of traditional tumor-related factors but, to our knowledge, these are the first data to show that low preoperative sodium concentration may be an important factor associated with reduced survival in patients with RCC, suggesting that serum sodium should be considered with established prognostic variables in modeling survival in RCC.