CAJ | 학술논문

目的探讨舒尼替尼治疗晚期肾癌患者的毒副反应对预后的影响.方法对2008至2011年复旦大学附属肿瘤医院泌尿外科行舒尼替尼治疗的136例晚期肾癌患者资料进行回顾性分析,其中男91例,女45例,平均年龄为56岁.舒尼替尼口服,每天50 mg,用药4周,间歇2周为1个疗程.中位随访15个月.采用Cox回归模型探讨舒尼替尼治疗过程中血细胞数变化与患者生存预后的相关性,并对P值进行多因素校正.应用Log-rank检验分析临床病理特征、毒副反应与患者总生存的相关性,应用Cox回归模型进行多因素分析.结果舒尼替尼治疗第1周期第14天的血红蛋白浓度(HR:0.950,95％ CI:0.923 ～0.978)和第28、42天的淋巴细胞计数(HR:0.405,95％ CI:0.203～0.809；HR:0.394,95％ CI:0.179 ～0.867)与患者的生存具有相关性(校正后P值分别为0.001、0.014和0.022).高血压Ⅲ/Ⅳ级(HR:0.066,95％ CI:0.008 ～0.582)、初筛时中性粒细胞数与淋巴细胞数比值(HR:2.537,95％CI:1.182 ～ 5.404)是生存预后的独立预测因子.结论舒尼替尼治疗周期中血细胞数变化与患者的生存预后相关.
목적 탐토서니체니치료만기신암환자적독부반응대예후적영향.방법 대2008지2011년복단대학부속종류의원비뇨외과행서니체니치료적136례만기신암환자자료진행회고성분석,기중남91례,녀45례,평균년령위56세.서니체니구복,매천50 mg,용약4주,간헐2주위1개료정.중위수방15개월.채용Cox회귀모형탐토서니체니치료과정중혈세포수변화여환자생존예후적상관성,병대P치진행다인소교정.응용Log-rank검험분석림상병리특정、독부반응여환자총생존적상관성,응용Cox회귀모형진행다인소분석.결과 서니체니치료제1주기제14천적혈홍단백농도(HR:0.950,95％ CI:0.923 ～0.978)화제28、42천적림파세포계수(HR:0.405,95％ CI:0.203～0.809；HR:0.394,95％ CI:0.179 ～0.867)여환자적생존구유상관성(교정후P치분별위0.001、0.014화0.022).고혈압Ⅲ/Ⅳ급(HR:0.066,95％ CI:0.008 ～0.582)、초사시중성립세포수여림파세포수비치(HR:2.537,95％CI:1.182 ～ 5.404)시생존예후적독립예측인자.결론 서니체니치료주기중혈세포수변화여환자적생존예후상관.
Objective To explore the effect of toxicity of sunitinib on the clinical outcome of patients with advanced renal cell carcinoma(RCC).Methods A total of 136 patients with advanced RCC were treated with sunitinib from 2008 to 2011.There were 91 males and 45 females with an average age of 56 years.Their 6-week therapy cycle was 4 weeks of sunitinib 50 mg daily followed by 2-week off-treatment (schedule4/2).The median follow-up time was 15 months.Correlation between toxicities and overall survival (OS) was evaluated in a Cox model using log-transformed levels after adjusting for MSKCC model.Log-rank test and Cox proportional hazard model were used to assess the value of drug toxicity as the prognostic factors.Results The increased hemoglobin on cycle 1 day 14 (HR:0.950,95％ CI:0.923-0.978) and the increased lymphocytes on cycle 1 days 28 and 42 (HR:0.405,95％ CI:0.203-0.809,HR:0.394,95％ CI:0.179-0.867) were significantly associated with OS (Padj =0.001,0.014 and 0.022respectively).Hypertension class Ⅲ/Ⅳ (HR:0.066,95％ CI:0.008-0.582),and the number of neutrophils screening and lymphocyte count ratio (HR:2.537,95％ CI:1.182-5.404) were the survival prognosis independent predictors.Conclusion Early hematopoietic toxicities may potentially predict the outcomes of advanced RCC after a therapy of sunitinib.