Sub-classification of patients with intermediate-risk metastatic renal cell carcinoma treated with targeted therapy
Sub-classification of patients with intermediate-risk metastatic renal cell carcinoma treated with targeted therapy
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DOI：
10.1093/jjco/hyz067
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发表时间：
2019-08-01
影响因子：
2.4
通讯作者：
Oyama，Masafumi
中科院分区：
文献类型：
--
作者：
Kaneko，Go;Shirotake，Suguru;Oyama，Masafumi
国际转移性肾细胞癌数据库联盟模型预测转移性肾癌的预后分为有利、中等和较差的风险组(分别为FG、IG和PG)，其中大约50%的患者被归类为IG。我们的目的是在IG子分类的基础上建立更好的风险模型。方法分析213例连续接受分子靶向治疗的患者的记录。根据年龄、性别、组织学、初始分子靶向治疗的类型、血清实验室数据、既往肾切除和免疫治疗以及转移部位进行IG亚分层。结果中位随访时间为17.8个月。血清白蛋白、血清C反应蛋白和骨转移是IG患者总生存期(OS)的独立预测因素。根据预测因素的数量，IG被细分为低风险IG、中风险IG和高风险IG。建立改良模型：改良FG(FG+低危IG)、改良IG(中危IG)和改良PG(PG+高危IG)。原始模型和修正模型的一致性指数分别为0.68和0.73(P<；0.001)。用哺乳动物靶点雷帕霉素抑制剂作为二线治疗的改良PG的OS明显长于用酪氨酸激酶抑制剂治疗的改良PG，而在原始模型中没有观察到这一点。结论我们成功地采用两步法建立了改良的IMDC模型：原始IMDC+IG亚层，并证明它比原始模型更准确地预测结果。
BackgroundInternational Metastatic Renal Cell Carcinoma Database Consortium model predicts the outcomes of metastatic renal cell carcinoma stratified into favorable, intermediate, and poor risk groups (FG, IG, and PG, respectively), with approximately 50% of patients being classified as IG. We aimed to generate better risk model based on the sub-classification of IG.MethodsWe analyzed records of 213 consecutive patients receiving molecular targeted therapy. Age, gender, histology, type of initial molecular targeted therapy, serum laboratory data, previous nephrectomy and immunotherapy, and metastatic sites were used for IG sub-stratification. Modified and original models were compared using a concordance correlation coefficient analysis.ResultsMedian follow-up was 17.8 months. Serum albumin, serum C-reactive protein, and bone metastases were independent predictors of overall survival (OS) in IG. IG was sub-classified into low-, middle-, and high-risk IG according to the number of predictors. The following modified model was developed: modified FG (FG & low-risk IG), modified IG (middle-risk IG), and modified PG (PG & high-risk IG). Concordance indices for original and modified models were 0.68 and 0.73, respectively (P< 0.001). OS was significantly longer in modified PG treated with mammalian target of rapamycin inhibitors as second-line therapy than with tyrosine kinase inhibitors, whereas this was not observed in the original model.ConclusionsWe successfully developed modified IMDC model using a two-step process: the original IMDC plus an IG sub-stratification, and demonstrated that it predicts outcomes more accurately than original model.