目的探究减瘤手术对肾癌骨转移患者生存预后的影响,为临床决策提供参考。方法本研究基于监测、流行病学和最终结果(surveillance,epidemiology,and end results,SEER)数据库分析,从数据库中收集大量多中心的肾癌患者的临床数据,分别通过...目的探究减瘤手术对肾癌骨转移患者生存预后的影响,为临床决策提供参考。方法本研究基于监测、流行病学和最终结果(surveillance,epidemiology,and end results,SEER)数据库分析,从数据库中收集大量多中心的肾癌患者的临床数据,分别通过logistic法分析了肾癌患者的骨转移的危险因素、Kaplan-Meier法绘制骨转移与非骨转移患者的生存曲线,Cox分析骨转移患者的预后影响因素,并使用倾向性评分匹配法去除混杂因素后分析了减瘤手术对肾癌骨转移患者的预后影响。结果本研究共纳入41221例肾癌患者,其中1038例发生了骨转移,通过对比,骨转移患者呈现以下临床特征:男性、年龄偏高、T分期较晚、多数合并淋巴结及其他器官转移。logistic分析结果显示肾癌骨转移的独立风险因素有:T分期高、合并淋巴结及其他远处器官转移。生存分析显示骨转移患者生存期远低于未转移患者。Cox回归分析显示高龄、T4、N1、远处转移是影响生存的独立危险因素,减瘤手术为独立保护因素。倾向性评分匹配后减瘤手术仍然是影响肾癌骨转移患者预后的独立保护因素。结论肾癌患者发生骨转移的风险因素包括T4肿瘤分期和肺转移。T4肿瘤分期和淋巴结转移通常预示预后不良。减瘤手术对患者生存预后的影响稳定,肾癌骨转移的患者可以通过减瘤手术获得生存获益。展开更多
Spontaneous regression of a malignant tumor is a very rare phenomenon.Renal cell carcinoma(RCC)is an aggressive malignancy with an often unpredictable behaviour.The incidence of spontaneous regression in metastatic RC...Spontaneous regression of a malignant tumor is a very rare phenomenon.Renal cell carcinoma(RCC)is an aggressive malignancy with an often unpredictable behaviour.The incidence of spontaneous regression in metastatic RCC has been estimated to lie between<1%and 7%.The spontaneous regression of a primary RCC has been reported much less commonly.Our literature review assesses the published literature concerning spontaneous regression of either primary or metastatic RCC.In order to examine this phenomenon in more detail we performed a literature search in the Pub Med Database using the Keywords"renal cell carcinoma","metastatic disease",and"spontaneous regression"and included reports from the last100 years.The incidence of spontaneous regressions in RCC has always been considered a special feature of RCC compared to other solid malignancies.The majority of case reports of spontaneously regressed RCC describe the regression of metastases after nephrectomy rather than the spontaneous regression of a primary tumor.In cases of reported regression of metastatic RCC,this mostly applied to pulmonarylesions.As possible reasons for spontaneous regressions host immune defense mechanisms against metastatic RCC tissue following nephrectomy are discussed as important factor.RCC is known to be highly immunogenic and the possible existence of cytotoxic serum factors and tumor-specific surface antigens may trigger a cell-mediated cytotoxicity as an immunological basis for regression.Histological verification of supposed regression of a primary tumor may cause diagnostic difficulties,since large central areas of necrosis and cystic lesions of the tumor can occur simultaneously.The well-known phenomenon of necrosis in a fast growing RCC at the time of nephrectomy must not be confused with true spontaneous regression.Therefore,in our opinion such reported cases of supposed partial spontaneous regressions of primary RCCs are highly questionable.Most cases of spontaneous regression of RCC metastases have been reported after nephrectomy as 展开更多
Background：The metastatic renal cell carcinoma （mRCC） patients treated with upfront cytoreductive nephrectomy combined with α-interferon yields additional overall survival （OS） benefits.It is unclear whether mRC...Background：The metastatic renal cell carcinoma （mRCC） patients treated with upfront cytoreductive nephrectomy combined with α-interferon yields additional overall survival （OS） benefits.It is unclear whether mRCC patients treated with vascular endothelial growth factor receptor-tyrosine kinase inhibitor （VEGFR-TKI） will benefit from such cytoreductive nephrectomy either.The aim of the study was to identify variables for selection of patients who would benefit from upfront cytoreductive nephrectomy for mRCC treated with VEGFR-TKI.Methods：Clinical data on 74 patients enrolled in 5 clinical trials conducted in Cancer Hospital （Institute）,Chinese Academy of Medical Sciences from January 2006 to January 2014 were reviewed retrospectively.The survival analysis was performed by the Kaplan-Meier method.Comparisons between patient groups were performed by Chi-square test.A Cox regression model was adopted for analysis of multiple factors affecting survival,with a significance level of α =0.05.Results：Fifty-one patients underwent cytoreductive nephrectomy followed by targeted therapy （cytoreductive nephrectomy group） and 23 patients were treated with targeted therapy alone （noncytoreductive nephrectomy group）.The median OS was 32.2 months and 23.0 months in cytoreductive nephrectomy and noncytoreductive nephrectomy groups,respectively （P =0.041）.Age ≤45 years （P =0.002）,a low or high body mass index （BMI 〈19 or 〉30 kg/m2） （P =0.008）,a serum lactate dehydrogenase （LDH） concentration 〉 1.5 × upper limit of normal （P =0.025）,a serum calcium concentration 〉1 0 mg/ml （P =0.034）,and 3 or more metastatic sites （P =0.023） were independent preoperative risk factors for survival.The patients only with 0-2 risk factors benefited from upfront cytoreductive nephrectomy in terms of OS when compared with the patients treated with targeted therapy alone （40.0 months vs.23.2 months,P =0.042）,while those with more than 2 risk factors did not.Conclusions：Five ri展开更多
目的:探索国际转移肾癌数据库联盟(International mRCC Database Consortium,IMDC)危险分层以外可以独立预测减瘤性肾切除术后患者总体死亡风险的因素,并构建联合预测模型,以指导手术适应证选择。方法:回顾性分析来自国际减瘤性肾切除...目的:探索国际转移肾癌数据库联盟(International mRCC Database Consortium,IMDC)危险分层以外可以独立预测减瘤性肾切除术后患者总体死亡风险的因素,并构建联合预测模型,以指导手术适应证选择。方法:回顾性分析来自国际减瘤性肾切除术临床研究协作组(International Consortium of Clinical Research on Cytoreductive Nephrectomy)全球13个医学中心减瘤性肾切除术治疗转移性肾癌264例患者资料,中位年龄63岁,男性占比73.9%,66.7%的患者合并肺转移,26.5%的患者合并骨转移,寡转移患者占比73.3%,IMDC中高危占比63.3%。基于Cox多因素分析结果构建减瘤性肾切除术后患者总体死亡风险的临床预测模型,并计算IMDC模型和联合模型的C-index值。基于纳入模型的变量系数间比例关系进行半定量赋值,绘制新模型不同分值患者队列的生存曲线并进行log-rank检验,分析新纳入变量在IMDC危险分层不同亚组的预测价值。计算新模型预测3年死亡风险的时依性ROC曲线下面积。结果:开放手术占比68.9%,术后病理学肿瘤最大径中位9(7.1,12.3) cm,透明细胞癌占81.8%,手术切缘阳性率6.1%,清扫淋巴结阳性率47.7%,二期手术行转移灶切除比例为8.3%。中位随访27.5(15.1,46.4)个月,随访期内死亡110例,总体死亡率41.7%。Cox多因素回归结果显示,IMDC危险分层和寡转移状态(Oligo-metastasis,影像学评估转移病灶数不超过5个,HR=2.089,96%CI:1.390~3.139,P<0.001)是患者术后总体死亡风险的独立预测因素。IMDC模型C-index值为0.598,IMDC-Olig联合模型C-index值为0.645。IMDC不同危险分层的亚组分析显示,在IMDC中危组和高危组,是否为寡转移两组患者术后总体死亡风险差异均有统计学意义(P<0.05,高危组差异仅限于1年生存率),IMDC低危组两者差异无统计学意义(P>0.05)。结论:IMDC-Olig模型可以很好地对IMDC中高危组患者基于总体死亡风险进行再分层,可作为手术适应证选择的�展开更多
文摘目的探究减瘤手术对肾癌骨转移患者生存预后的影响,为临床决策提供参考。方法本研究基于监测、流行病学和最终结果(surveillance,epidemiology,and end results,SEER)数据库分析,从数据库中收集大量多中心的肾癌患者的临床数据,分别通过logistic法分析了肾癌患者的骨转移的危险因素、Kaplan-Meier法绘制骨转移与非骨转移患者的生存曲线,Cox分析骨转移患者的预后影响因素,并使用倾向性评分匹配法去除混杂因素后分析了减瘤手术对肾癌骨转移患者的预后影响。结果本研究共纳入41221例肾癌患者,其中1038例发生了骨转移,通过对比,骨转移患者呈现以下临床特征:男性、年龄偏高、T分期较晚、多数合并淋巴结及其他器官转移。logistic分析结果显示肾癌骨转移的独立风险因素有:T分期高、合并淋巴结及其他远处器官转移。生存分析显示骨转移患者生存期远低于未转移患者。Cox回归分析显示高龄、T4、N1、远处转移是影响生存的独立危险因素,减瘤手术为独立保护因素。倾向性评分匹配后减瘤手术仍然是影响肾癌骨转移患者预后的独立保护因素。结论肾癌患者发生骨转移的风险因素包括T4肿瘤分期和肺转移。T4肿瘤分期和淋巴结转移通常预示预后不良。减瘤手术对患者生存预后的影响稳定,肾癌骨转移的患者可以通过减瘤手术获得生存获益。
文摘Spontaneous regression of a malignant tumor is a very rare phenomenon.Renal cell carcinoma(RCC)is an aggressive malignancy with an often unpredictable behaviour.The incidence of spontaneous regression in metastatic RCC has been estimated to lie between<1%and 7%.The spontaneous regression of a primary RCC has been reported much less commonly.Our literature review assesses the published literature concerning spontaneous regression of either primary or metastatic RCC.In order to examine this phenomenon in more detail we performed a literature search in the Pub Med Database using the Keywords"renal cell carcinoma","metastatic disease",and"spontaneous regression"and included reports from the last100 years.The incidence of spontaneous regressions in RCC has always been considered a special feature of RCC compared to other solid malignancies.The majority of case reports of spontaneously regressed RCC describe the regression of metastases after nephrectomy rather than the spontaneous regression of a primary tumor.In cases of reported regression of metastatic RCC,this mostly applied to pulmonarylesions.As possible reasons for spontaneous regressions host immune defense mechanisms against metastatic RCC tissue following nephrectomy are discussed as important factor.RCC is known to be highly immunogenic and the possible existence of cytotoxic serum factors and tumor-specific surface antigens may trigger a cell-mediated cytotoxicity as an immunological basis for regression.Histological verification of supposed regression of a primary tumor may cause diagnostic difficulties,since large central areas of necrosis and cystic lesions of the tumor can occur simultaneously.The well-known phenomenon of necrosis in a fast growing RCC at the time of nephrectomy must not be confused with true spontaneous regression.Therefore,in our opinion such reported cases of supposed partial spontaneous regressions of primary RCCs are highly questionable.Most cases of spontaneous regression of RCC metastases have been reported after nephrectomy as
文摘Background：The metastatic renal cell carcinoma （mRCC） patients treated with upfront cytoreductive nephrectomy combined with α-interferon yields additional overall survival （OS） benefits.It is unclear whether mRCC patients treated with vascular endothelial growth factor receptor-tyrosine kinase inhibitor （VEGFR-TKI） will benefit from such cytoreductive nephrectomy either.The aim of the study was to identify variables for selection of patients who would benefit from upfront cytoreductive nephrectomy for mRCC treated with VEGFR-TKI.Methods：Clinical data on 74 patients enrolled in 5 clinical trials conducted in Cancer Hospital （Institute）,Chinese Academy of Medical Sciences from January 2006 to January 2014 were reviewed retrospectively.The survival analysis was performed by the Kaplan-Meier method.Comparisons between patient groups were performed by Chi-square test.A Cox regression model was adopted for analysis of multiple factors affecting survival,with a significance level of α =0.05.Results：Fifty-one patients underwent cytoreductive nephrectomy followed by targeted therapy （cytoreductive nephrectomy group） and 23 patients were treated with targeted therapy alone （noncytoreductive nephrectomy group）.The median OS was 32.2 months and 23.0 months in cytoreductive nephrectomy and noncytoreductive nephrectomy groups,respectively （P =0.041）.Age ≤45 years （P =0.002）,a low or high body mass index （BMI 〈19 or 〉30 kg/m2） （P =0.008）,a serum lactate dehydrogenase （LDH） concentration 〉 1.5 × upper limit of normal （P =0.025）,a serum calcium concentration 〉1 0 mg/ml （P =0.034）,and 3 or more metastatic sites （P =0.023） were independent preoperative risk factors for survival.The patients only with 0-2 risk factors benefited from upfront cytoreductive nephrectomy in terms of OS when compared with the patients treated with targeted therapy alone （40.0 months vs.23.2 months,P =0.042）,while those with more than 2 risk factors did not.Conclusions：Five ri
文摘目的:探索国际转移肾癌数据库联盟(International mRCC Database Consortium,IMDC)危险分层以外可以独立预测减瘤性肾切除术后患者总体死亡风险的因素,并构建联合预测模型,以指导手术适应证选择。方法:回顾性分析来自国际减瘤性肾切除术临床研究协作组(International Consortium of Clinical Research on Cytoreductive Nephrectomy)全球13个医学中心减瘤性肾切除术治疗转移性肾癌264例患者资料,中位年龄63岁,男性占比73.9%,66.7%的患者合并肺转移,26.5%的患者合并骨转移,寡转移患者占比73.3%,IMDC中高危占比63.3%。基于Cox多因素分析结果构建减瘤性肾切除术后患者总体死亡风险的临床预测模型,并计算IMDC模型和联合模型的C-index值。基于纳入模型的变量系数间比例关系进行半定量赋值,绘制新模型不同分值患者队列的生存曲线并进行log-rank检验,分析新纳入变量在IMDC危险分层不同亚组的预测价值。计算新模型预测3年死亡风险的时依性ROC曲线下面积。结果:开放手术占比68.9%,术后病理学肿瘤最大径中位9(7.1,12.3) cm,透明细胞癌占81.8%,手术切缘阳性率6.1%,清扫淋巴结阳性率47.7%,二期手术行转移灶切除比例为8.3%。中位随访27.5(15.1,46.4)个月,随访期内死亡110例,总体死亡率41.7%。Cox多因素回归结果显示,IMDC危险分层和寡转移状态(Oligo-metastasis,影像学评估转移病灶数不超过5个,HR=2.089,96%CI:1.390~3.139,P<0.001)是患者术后总体死亡风险的独立预测因素。IMDC模型C-index值为0.598,IMDC-Olig联合模型C-index值为0.645。IMDC不同危险分层的亚组分析显示,在IMDC中危组和高危组,是否为寡转移两组患者术后总体死亡风险差异均有统计学意义(P<0.05,高危组差异仅限于1年生存率),IMDC低危组两者差异无统计学意义(P>0.05)。结论:IMDC-Olig模型可以很好地对IMDC中高危组患者基于总体死亡风险进行再分层,可作为手术适应证选择的�
