Evaluation of the prognostic role of co-morbidities on disease outcome in renal cell carcinoma patients
Evaluation of the prognostic role of co-morbidities on disease outcome in renal cell carcinoma patients
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DOI：
10.1007/s00345-019-02930-4
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发表时间：
2020-06-01
影响因子：
3.4
通讯作者：
Kroeger, Nils
中科院分区：
文献类型：
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作者：
Heide, Johannes;Ribback, Silvia;Kroeger, Nils
背景：合并症可诱导肾细胞癌（RCC）的局部和全身肿瘤进展;然而，合并症的预后影响尚未得到很好的表征。患者和方法RCC患者（n = 2206）手术治疗的三个学术机构在美国和欧洲被纳入分析。研究糖尿病、高血压、慢性肾病、慢性阻塞性肺病、冠心病和甲状腺功能减退症与临床病理特征和癌症特异性生存率的关系。结果单因素分析显示，高血压患者T分期较低（p = 0.025），淋巴结转移（p = 0.026）和远处转移（p = 0.001）风险较低，肿瘤特异性生存率较低（HR 0.8195% CI 0.69-0.96，p = 0.013）。然而，在调整TNM分期、分级和ECOG体力状态后，高血压不是独立的预后因素（HR 0.95，95% CI 0.80-1.12; p = 0.530）。未发现合并使用抗高血压药物与生存结局改善之间的相关性。所有其他研究的共病与临床病理学特征或癌症特异性生存期无显著相关性。结论尽管所研究的合并症能够或诱导病理生理学变化，这些变化是肿瘤进展的易感因素，但在RCC患者中没有一个是独立的预后因素。
Background Co-morbidities may induce local and systemic tumor progression of renal cell carcinoma (RCC); however, the prognostic impact of co-morbidities has not yet been well characterized. Patients and methods RCC patients (n = 2206) surgically treated at three academic institutions in the US and Europe were included in the analysis. Presence of diabetes mellitus, hypertension, chronic kidney disease, chronic obstructive pulmonary disease, coronary heart disease, and hypothyroidism were investigated for their association with clinicopathological features and cancer-specific survival. Results Hypertension was associated with less advanced T stages (p = 0.025), a lower risk of lymph-node (p = 0.026) and distant metastases (p = 0.001), and improved cancer specific survival in univariable analysis (HR 0.81 95% CI 0.69-0.96, p = 0.013). However, hypertension was not an independent prognostic factor after adjustment for TNM stages, grading, and ECOG performance status (HR 0.95, 95% CI 0.80-1.12; p = 0.530). A correlation between the use of concomitant anti-hypertensive medications and improved survival outcome was not identified. All other investigated co-morbidities did not show significant associations with clinicopathological features or cancer-specific survival. Conclusion Although the investigated co-morbidities are capable or inducing pathophysiological changes that are predisposing factors for tumor progression, none is an independent prognostic factor in patients with RCC.