舒尼替尼治疗46例转移性肾癌的预后因素分析
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摘要
目的分析舒尼替尼治疗转移性肾癌(mRCC)的预后因素。方法回顾性分析2008年1月~2013年12月在我院使用舒尼替尼治疗的46例mRCC患者的临床资料。采用Kaplan-Meier生存分析法计算患者的生存率,Log-rank检验生存率差异,应用Cox比例回归风险模型分析影响预后的相关因素。结果本组46例的中位总生存时间为27.8个月(95%CI:15.7~39.9个月),客观缓解率为21.7%,疾病控制率为69.5%。Kaplan-Meier生存分析结果显示1年、2年、3年总生存率分别为77.8%、57.2%、38.7%。单因素分析:确诊至开始治疗时间<1年(P<0.01)、ECOG评分>2分(P<0.01)、未行肾根治性切除术/减瘤术(P<0.01)、非肺转移(P=0.045)、骨转移(P<0.01)、肝转移(P<0.01)、多器官转移(P=0.012)、MSKCC模型评分为高危(P<0.01)、舒尼替尼1M-RDI<50%(P<0.01)影响转移性肾癌的总生存期。Cox多因素分析显示诊断至接受治疗时间间隔(<1年与≥1年)、肿瘤转移器官数目(1个与≥1个)是舒尼替尼治疗转移性肾癌总生存期的独立预后因素(P<0.05),是影响转移性肾癌预后的独立因素。结论治疗时间间隔≥1年以及单一器官转移的转移性肾癌患者接受舒尼替尼治疗能够获得较好的总生存时间,是影响转移性肾癌预后的独立因素。
Objective To analyze the prognostic factors of sunitinib in the treatment of metastatic renal carcinoma.Methods The clinical data of 46 patients with m RCC treated with sunitinib in our hospital from January 2008 to December 2013 were retrospectively analyzed. Kaplan-Meier survival analysis was used to calculate the survival rate of the patients, and Log-rank test was used to test the differences of survival rate. The Cox proportional regression risk model was used to analyze the relevant influencing factors for prognosis. Results The median overall survival time was27.8 months(95%CI: 15.7 to 39.9 months) in 46 patients in this group, and the objective remission rate was 21.7%.The disease control rate was 69.5%. Kaplan-Meier survival analysis showed that 1-year, 2-year, 3-year overall survival rates were 77.8%, 57.2% and 38.7%, respectively. Univariate analysis: treatment time less than one year from diagnosis to beginning of treatment(P<0.01), ECOG score>2 points(P<0.01), no radical nephrectomy/tumor cytoreduction(P<0.01), non-pulmonary metastasis(P=0.045), bone metastasis(P<0.01), liver metastasis(P<0.01), multiple organ metastasis(P=0.012), MSKCC model score in high risk(P<0.01), relative dose density of sunitinib in the first month <50%(P<0.01) all affected the overall survival of metastatic renal carcinoma. Cox multivariate analysis showed the interval from diagnosis to treatment(<1 year and ≥1 year) and the number of metastatic organs(1 and ≥1) were independent prognostic factors of sunitinib in the treatment of overall survival of metastatic renal carcinoma(P<0.05), which was an independent factor affecting the prognosis of metastatic renal carcinoma. Conclusion Sunitinib for the patients with metastatic renal carcinoma at a time interval of ≥1 year and single organ metastasis can achieve a good overall survival time and is an independent factor affecting the prognosis of metastatic renal carcinoma.
Objective To analyze the prognostic factors of sunitinib in the treatment of metastatic renal carcinoma.Methods The clinical data of 46 patients with m RCC treated with sunitinib in our hospital from January 2008 to December 2013 were retrospectively analyzed. Kaplan-Meier survival analysis was used to calculate the survival rate of the patients, and Log-rank test was used to test the differences of survival rate. The Cox proportional regression risk model was used to analyze the relevant influencing factors for prognosis. Results The median overall survival time was27.8 months(95%CI: 15.7 to 39.9 months) in 46 patients in this group, and the objective remission rate was 21.7%.The disease control rate was 69.5%. Kaplan-Meier survival analysis showed that 1-year, 2-year, 3-year overall survival rates were 77.8%, 57.2% and 38.7%, respectively. Univariate analysis: treatment time less than one year from diagnosis to beginning of treatment(P<0.01), ECOG score>2 points(P<0.01), no radical nephrectomy/tumor cytoreduction(P<0.01), non-pulmonary metastasis(P=0.045), bone metastasis(P<0.01), liver metastasis(P<0.01), multiple organ metastasis(P=0.012), MSKCC model score in high risk(P<0.01), relative dose density of sunitinib in the first month <50%(P<0.01) all affected the overall survival of metastatic renal carcinoma. Cox multivariate analysis showed the interval from diagnosis to treatment(<1 year and ≥1 year) and the number of metastatic organs(1 and ≥1) were independent prognostic factors of sunitinib in the treatment of overall survival of metastatic renal carcinoma(P<0.05), which was an independent factor affecting the prognosis of metastatic renal carcinoma. Conclusion Sunitinib for the patients with metastatic renal carcinoma at a time interval of ≥1 year and single organ metastasis can achieve a good overall survival time and is an independent factor affecting the prognosis of metastatic renal carcinoma.
引文
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[13]李昊,姚启盛,陈从波,等.舒尼替尼治疗肾转移癌疗效的影响因素分析[J].实用癌症杂志,2015,30(9):1311.
[14]鲜鹏,罗宏,周宏,等.舒尼替尼对肾透明细胞癌不同转移灶疗效的探讨[J].临床泌尿外科杂志,2011,26(5);330.
[15]Ibrahim EM,Kazkaz GA,Abouelkhair KM,et al.Sunitinib adverse events inmetastatic renal cell carcinoma:A meta-analysis[J].Int J Clin Oncol,2013,18:1060-1069.
[16]Lix S,Wu X,Zhao P J,et al.Efficacy and safety of sunitinib in the treatment of metastatic renal cell carcinoma[J].Chin Med J(Engl),2011,124(18):2920-2924.
[17]洪雅萍,姚旭东,朱耀,等.舒尼替尼治疗晚期肾细胞癌患者的毒副反应对预后的影响[J].中华医学杂志,2013,93(36):2880.
[18]蔡林,张崔建,李学松,等.舒尼替尼治疗转移性肾细胞癌的疗效和不良反应及其相关性分析[J].中华泌尿外科杂志,2014,35(6):425-428.
[19]施国海,叶定伟,姚旭东,等.舒尼替尼治疗转移性肾癌的近期疗效及耐受性[J].中华泌尿外科杂志,2011,32(6):423-426.
[20]叶定伟,施国海.中国应用舒尼替尼治疗晚期肾癌的Ⅳ期临床结果[J].中华泌尿外科杂志,2012,33(4):245-246.
[2]Silberstein JL,Adamy A,Maschino AC,et al.Systematic classification and prediction of complications after nephrectomy in patients with metastatic renal cell carcinoma(RCC)[J].BJU Int,2012,110(9):1276-1282.
[3]Heng DY,Xie W,Regan MM,et al.Prognostic factors for overall survival in patients with metastatic renal cell carcinoma treated with vascular endothelial growth factortargeted agents:results from a large,multicenter study[J].J Clin Oncol,2009,27(34):5794-5799.
[4]CSCO肾癌专家委员会.中国肾癌诊治指南(2015版)[M].北京:人民卫生出版社,2015:128-130.
[5]蔡贤福,钟武,陈睦虎,等.舒尼替尼治疗转移性肾癌疗效的Meta分析[J].武汉大学学报:医学版,2015,36(1):82-85.
[6]Motzer RJ,Hutson TE,Tomczak P,et al.Sunitinib versus interferon alfa in metastatic renal cell carcinoma[J].N Engl J Med,2007,356(2):115-124.
[7]Motzer RJ,Hutson TE,Tomczak P,et al.Overall survival and updated results for sunitinib compared with interferon-alfa in patients with metastatic renal cell carcinoma[J].J Clin Oncol,2009,27:3584-3590.
[8]Qin SK,Jin J,Guo J.A phase IV multicenter study of the efficacy and safety of sunitinib as first-line therapy in Chinese patients with metastatic renal cell carcinoma[C].Ann Onc,2012:851P.
[9]Paglino C,Imarisio I,Ganini C,et al.Sunitinib in advanced metastatic nonclear cell renal cell carcinoma:A single institution retrospective study[J].Future Oncol,2012;8(12):1605-1612.
[10]Shi HZ,Tian J,Li CL.Safety and efficacy of sunitinib for advanced non-clear cell renal cell carcinoma[J].Asia Pac J Clin Oncol,2015,11(4):328-333.
[11]Zhang H,Dong B,Lu J,et al.Efficacy of sorafenib on metastatic renal cell carcinoma in Asian patients:Results from a multi-center study[J].BMC Cancer,2009,9:249-256.
[12]Motzer RJ,Bukowski RM,Figlin RA,et al.Prognostic nomogram for sunitinib in patients with metastatic renal cell carcinoma[J].Cancer,2008,113(7):1552-1558.
[13]李昊,姚启盛,陈从波,等.舒尼替尼治疗肾转移癌疗效的影响因素分析[J].实用癌症杂志,2015,30(9):1311.
[14]鲜鹏,罗宏,周宏,等.舒尼替尼对肾透明细胞癌不同转移灶疗效的探讨[J].临床泌尿外科杂志,2011,26(5);330.
[15]Ibrahim EM,Kazkaz GA,Abouelkhair KM,et al.Sunitinib adverse events inmetastatic renal cell carcinoma:A meta-analysis[J].Int J Clin Oncol,2013,18:1060-1069.
[16]Lix S,Wu X,Zhao P J,et al.Efficacy and safety of sunitinib in the treatment of metastatic renal cell carcinoma[J].Chin Med J(Engl),2011,124(18):2920-2924.
[17]洪雅萍,姚旭东,朱耀,等.舒尼替尼治疗晚期肾细胞癌患者的毒副反应对预后的影响[J].中华医学杂志,2013,93(36):2880.
[18]蔡林,张崔建,李学松,等.舒尼替尼治疗转移性肾细胞癌的疗效和不良反应及其相关性分析[J].中华泌尿外科杂志,2014,35(6):425-428.
[19]施国海,叶定伟,姚旭东,等.舒尼替尼治疗转移性肾癌的近期疗效及耐受性[J].中华泌尿外科杂志,2011,32(6):423-426.
[20]叶定伟,施国海.中国应用舒尼替尼治疗晚期肾癌的Ⅳ期临床结果[J].中华泌尿外科杂志,2012,33(4):245-246.