Natural history of untreated renal cell carcinoma with venous tumor thrombus
Natural history of untreated renal cell carcinoma with venous tumor thrombus
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DOI：
10.1016/j.urolonc.2011.12.006
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发表时间：
2013-10-01
影响因子：
2.7
通讯作者：
Meng, Maxwell V.
中科院分区：
文献类型：
--
作者：
Reese, Adam C.;Whitson, Jared M.;Meng, Maxwell V.
目的：未经治疗的肾细胞癌（RCC）伴静脉癌栓（VTT）的自然病程特征不明确。我们的目的是描述这种疾病的自然史，并确定与疾病特异性survival.Materials和方法相关的预后因素：我们确定了患者在监测，流行病学和最终结果（SEER）数据库与未经治疗的肾细胞癌和静脉肿瘤血栓。确定疾病特异性中位生存率和1年生存率，并使用Kaplan-Meier方法绘制无病生存曲线。多变量考克斯回归分析，以确定相关因素与疾病特异性和总生存率在this patient group.Results：2,265例肾细胞癌和VTT，390（17%）没有接受治疗，278（71%）患者在随访期间死亡，其中，243例死亡（87%）是由于肾细胞癌。该组的中位和1年疾病特异性生存期分别为5个月和29%。在多变量分析中，肿瘤血栓的程度（HR 1.7 T3 c与T3 b，95%CI 1.0-2.7）和转移的存在（HR 3.1 M+与MO，95%CI 1.7-5.5）与疾病特异性mortality.Conclusions：预后差，大多数未经治疗的RCC和VTT患者。膈上血栓和远处转移是该患者组的不良预后因素。当咨询患者手术与非手术治疗RCC和VTT的风险和益处时，这些信息非常重要。(C)2013 Elsevier Inc. All rights reserved.
Objectives: The natural history of untreated renal cell carcinoma (RCC) with venous tumor thrombus (VTT) is poorly characterized. We aimed to describe the natural history of this disease, and to identify prognostic factors associated with disease-specific survival.Materials and methods: We identified patients in the Surveillance, Epidemiology, and End Results (SEER) database with untreated renal cell carcinoma and venous tumor thrombi. Disease-specific median and 1-year survival rates were determined, and disease-free survival curves were plotted using the Kaplan-Meier method. Multivariable Cox regression analyses were performed to identify factors associated with disease-specific and overall survival in this patient group.Results: Of 2,265 patients with RCC and VTT, 390 (17%) underwent no treatment; 278 (71%) patients died during follow-up; of these, 243 deaths (87%) were due to RCC. Median and 1-year disease-specific survival for this group was 5 months and 29%, respectively. On multivariable analysis, the extent of tumor thrombus (HR 1.7 for T3c vs. T3b, 95% CI 1.0-2.7) and the presence of metastases (HR 3.1 for M+ vs. MO, 95% CI 1.7-5.5) were most strongly associated with disease-specific mortality.Conclusions: Prognosis is poor for the majority of untreated patients with RCC and VTT. Supradiaphragmatic thrombi and distant metastases are adverse prognostic factors in this patient group. This information is important when counseling patients as to the risk and benefits of surgical vs. nonoperative management of RCC and VTT. (C) 2013 Elsevier Inc. All rights reserved.