Prognostic Factors for Overall Survival in Patients With Metastatic Renal Cell Carcinoma Treated With Vascular Endothelial Growth Factor-Targeted Agents: Results From a Large, Multicenter Study
Prognostic Factors for Overall Survival in Patients With Metastatic Renal Cell Carcinoma Treated With Vascular Endothelial Growth Factor-Targeted Agents: Results From a Large, Multicenter Study
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DOI：
10.1200/jco.2008.21.4809
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发表时间：
2009-12-01
影响因子：
45.3
通讯作者：
Choueiri, Toni K.
中科院分区：
文献类型：
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作者：
Heng, Daniel Y. C.;Xie, Wanling;Choueiri, Toni K.
PurposeThere是没有强大的数据预后因素的总生存期（OS）在转移性肾细胞癌（RCC）患者治疗血管内皮生长因子（VEGF）靶向therapy.MethodsBaseline的特点和结果，对645例抗VEGF治疗初治转移性RCC收集了来自三个美国和四个加拿大癌症中心。考克斯比例风险回归，然后通过自举验证，被用来确定独立的预后因素OS。ResultsThe中位OS为整个队列为22个月（95%CI，20.2至26.5个月），中位随访时间为24.5个月。总体而言，分别有396、200和49例患者接受舒尼替尼、索拉非尼和贝伐珠单抗治疗。根据纪念斯隆-凯特琳癌症中心（MSKCC）的五个不良预后因素中有四个是短生存期的独立预测因素：血红蛋白低于正常下限（P < .0001），校正钙大于正常上限（ULN; P = .0006），Karnofsky体力状态小于80%（P < .0001），从诊断到治疗的时间小于1年（P < .01）。此外，中性粒细胞大于ULN（P <0.0001）和血小板大于ULN（P = 0.01）是独立的不良预后因素。患者被分为三个风险类别：（无预后因素; n = 133），未达到中位OS（mOS），2年OS（2年OS）为75%;中危组（一个或两个预后因素; n = 301），其中mOS为27个月，2年OS为53%;低风险组（3至6个预后因素; n = 152），其中mOS为8.8个月，2年OS为7%（对数秩P < .0001）。C指数为0.73。结论该模型验证了MSKCC模型的组成部分，增加了血小板和中性粒细胞计数，可以纳入患者护理和使用VEGF靶向药物的临床试验。
PurposeThere are no robust data on prognostic factors for overall survival ( OS) in patients with metastatic renal cell carcinoma (RCC) treated with vascular endothelial growth factor (VEGF)-targeted therapy.MethodsBaseline characteristics and outcomes on 645 patients with anti-VEGF therapy-naive metastatic RCC were collected from three US and four Canadian cancer centers. Cox proportional hazards regression, followed by bootstrap validation, was used to identify independent prognostic factors for OS.ResultsThe median OS for the whole cohort was 22 months (95% CI, 20.2 to 26.5 months), and the median follow-up was 24.5 months. Overall, 396, 200, and 49 patients were treated with sunitinib, sorafenib, and bevacizumab, respectively. Four of the five adverse prognostic factors according to the Memorial Sloan-Kettering Cancer Center (MSKCC) were independent predictors of short survival: hemoglobin less than the lower limit of normal (P < .0001), corrected calcium greater than the upper limit of normal (ULN; P = .0006), Karnofsky performance status less than 80% (P < .0001), and time from diagnosis to treatment of less than 1 year (P < .01). In addition, neutrophils greater than the ULN (P < .0001) and platelets greater than the ULN (P = .01) were independent adverse prognostic factors. Patients were segregated into three risk categories: the favorable-risk group ( no prognostic factors; n = 133), in which median OS (mOS) was not reached and 2-year OS (2y OS) was 75%; the intermediate-risk group ( one or two prognostic factors; n = 301), in which mOS was 27 months and 2y OS was 53%; and the poor-risk group ( three to six prognostic factors; n = 152), in which mOS was 8.8 months and 2y OS was 7% (log-rank P < .0001). The C-index was 0.73.ConclusionThis model validates components of the MSKCC model with the addition of platelet and neutrophil counts and can be incorporated into patient care and into clinical trials that use VEGF-targeted agents.