Treatment outcome and prognostic factors in renal cell cancer patients with bone metastasis
Treatment outcome and prognostic factors in renal cell cancer patients with bone metastasis
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DOI：
10.1007/s10585-011-9379-7
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发表时间：
2011-04-01
影响因子：
4
通讯作者：
Fukui, Iwao
中科院分区：
文献类型：
--
作者：
Yuasa, Takeshi;Urakami, Shinji;Fukui, Iwao
我们回顾性分析了肾细胞癌骨转移患者的治疗结果和预后不良的因素。对1984年至2009年在我院治疗的原发性肾癌骨转移患者进行回顾性分析。在214例有转移的RCC患者中，71例（33%）在初次诊断转移时发现骨转移。中位随访时间为21.1个月（四分位数内范围：IQR，9.1-47.4个月）。从诊断为骨转移开始的估计中位总生存时间为27.7个月。患者在1年、2年和5年的生存概率分别为63.7%、52.2%和19.3%。当按MSKCC评分进行分层时，分类为有利、中等和差的人群的中位总生存期的概率分别为32.9和10.5个月（P = 0.002）。此外，通过多变量分析，将较差的体能状态（PS）（风险比[HR]：1.938，P = 0.035）和既往无肾切除术（HR：3.008，P = 0.004）提取为独立的不良预后因素。所有的治疗方式包括根治性整块手术、放射治疗、细胞因子治疗、分子靶向治疗和唑来膦酸给药似乎都有助于有利的生存。超过一半的RCC继发性骨转移患者预计生存时间超过24个月。在该人群中，MSKCC评分是有效的生存预测因子。随着治疗选择的增加，伴有骨转移的RCC患者可能会从后续方式和/或药物中进一步受益。
We retrospectively analyzed treatment outcomes and factors for poor prognosis for patients with renal cell cancer (RCC) bone metastases. Patients with bone metastases at initial diagnosis of metastasis secondary from RCC, treated at our hospital between 1984 and 2009, were retrospectively reviewed and statistically analyzed. Among 214 RCC patients with metastasis, 71 patients (33%) were found to have bone metastases at initial diagnosis of metastasis. The median follow-up was 21.1 months (intra-quartile range: IQR, 9.1-47.4 months). The estimated median overall survival time from the diagnosis of bone metastasis was 27.7 months. The probability of patients surviving at 1, 2, and 5 years was 63.7, 52.2, and 19.3%, respectively. When they were stratified by MSKCC scores, the probability of the median overall survival of the populations classified as favorable, intermediate, and poor was not reached, 32.9, and 10.5 months, respectively (P = 0.002). In addition, poor performance status (PS) (hazard ratio [HR]: 1.938, P = 0.035) and no prior nephrectomy (HR: 3.008, P = 0.004) were extracted as independent poor prognostic factors by multivariate analysis. All treatment modalities-including radical en bloc surgery, radiation therapy, cytokine therapy, molecular targeted therapy, and administration of zoledronic acid-seemed to contribute to favorable survival. More than half of the patients with bone metastases secondary from RCC were predicted to survive more than 24 months. In this population, MSKCC scores were valid predictors of survival. With increased treatment options, RCC patients with bone metastasis may benefit further from subsequent modalities and/or agents.