Prognostic factors for survival in previously treated patients with metastatic renal cell carcinoma
Prognostic factors for survival in previously treated patients with metastatic renal cell carcinoma
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DOI：
10.1200/jco.2004.06.132
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发表时间：
2004-02-01
影响因子：
45.3
通讯作者：
Mazumdar, M
中科院分区：
文献类型：
--
作者：
Motzer, RJ;Bacik, J;Mazumdar, M
目的描述已治疗的转移性肾细胞癌(RCC)患者的生存情况。方法对1975-2002年间连续29次临床试验中251例晚期RCC患者的治疗前临床特征与生存的关系进行研究。结果251例患者的中位生存期为10.2个月，且随治疗年限的不同而不同，1990年后治疗的患者生存时间较长。本组患者中位总生存期为12.7个月。因为这项分析的目的是为目前的临床试验设计建立预后因素，所以对这些患者进行了预后因素分析。在多变量分析中，与较短生存期相关的治疗前特征是低卡诺夫斯基状态、低血红蛋白水平和高校正血钙。这些被用作危险因素，将患者分为三个不同的组。无危险因素患者的中位死亡时间为22个月。有这些预后因素之一的患者的中位生存期为11.9个月。有两个或三个危险因素的患者中位生存期为5.4个月。结论对于进展为细胞因子治疗的转移性肾癌患者，在临床试验期间使用新型药物是可行的。用于预测生存的三个预后因素被用来将患者分类为危险组。这些风险类别可用于临床试验设计和解释。(C)2004年，由美国临床肿瘤学会提供。
Purpose To describe survival in previously treated patients with metastatic renal cell carcinoma (RCC) who are candidates for clinical trials of new agents as second-line therapy.Patients and Methods The relationship between pretreatment clinical features and survival was studied in 251 patients with advanced RCC treated during 29 consecutive clinical trials between 1975 and 2002. Clinical features were first examined in univariate analyses, and then a stepwise modeling approach based on Cox regression was used to form a multivariate model.Results Median survival for the 251 patients was 10.2 months and differed according to year of treatment, with patients treated after 1990 showing longer survival. In this group, the median overall survival time was 12.7 months. Because the purpose of this analysis was to establish prognostic factors for present-day clinical trial design, prognostic factor analysis was performed on these patients. Pretreatment features associated with a shorter survival in the multivariate analysis were low Karnofsky performance status, low hemoglobin level, and high corrected serum calcium. These were used as risk factors to categorize patients into three different groups. The median time to death in patients with zero risk factors was 22 months. The median survival in patients with one of these prognostic factors was 11.9 months. Patients with two or three risk factors had a median survival of 5.4 months.Conclusion Treatment with novel agents during a clinical trial is indicated for patients with metastatic RCC after progression to cytokine treatment. Three prognostic factors for predicting survival were used to categorize patients into risk groups. These risk categories can be used in clinical trial design and interpretation. (C) 2004 by American Society of Clinical Oncology.