CAJ | 학술논문

目的探讨肾癌骨转移患者应用靶向药物治疗影响预后的因素. 方法回顾性分析2007年6月至2013年4月采用靶向药物治疗的45例肾癌骨转移患者的临床资料.男33例,女12例.年龄32～81岁,平均59岁.27例诊断肾癌时即合并骨转移,余18例从诊断肾癌到发生骨转移的中位时间为12.5个月.采用索拉非尼治疗38例,舒尼替尼治疗7例.分别对患者的总生存期(OS)进行单因素风险分析,探讨影响预后的危险因素.利用Cox比例风险模型对单因素风险分析筛选的危险因素进行多因素预后分析,并确定独立风险因素.根据独立风险因素将患者分为高危组(≤1项有利因素)和低危组(＞l项有利因素),比较两组患者的中位OS. 结果本组45例的中位OS为19个月,1年生存率为74.7％,2年生存率为32.7％.多因素分析结果表明靶向药物治疗肾癌骨转移患者的有利因素为:诊断肾癌时无骨转移(HR:2.401,95％CI:1.210～5.699)、原发灶切除(HR:2.635,95％CI:1.021～6.307)、无骨以外器官转移(HR:2.323,95％CI:1.003～6.221).高危组23例,中位OS为16个月,低危组22例,中位OS为22个月,两组比较差异有统计学意义(P＜0.05). 结论原发灶切除、无骨以外器官转移、诊断肾癌时无骨转移是肾癌骨转移患者靶向药物治疗预后的有利因素.
목적 탐토신암골전이환자응용파향약물치료영향예후적인소. 방법 회고성분석2007년6월지2013년4월채용파향약물치료적45례신암골전이환자적림상자료.남33례,녀12례.년령32～81세,평균59세.27례진단신암시즉합병골전이,여18례종진단신암도발생골전이적중위시간위12.5개월.채용색랍비니치료38례,서니체니치료7례.분별대환자적총생존기(OS)진행단인소풍험분석,탐토영향예후적위험인소.이용Cox비례풍험모형대단인소풍험분석사선적위험인소진행다인소예후분석,병학정독립풍험인소.근거독립풍험인소장환자분위고위조(≤1항유리인소)화저위조(＞l항유리인소),비교량조환자적중위OS. 결과 본조45례적중위OS위19개월,1년생존솔위74.7％,2년생존솔위32.7％.다인소분석결과표명파향약물치료신암골전이환자적유리인소위:진단신암시무골전이(HR:2.401,95％CI:1.210～5.699)、원발조절제(HR:2.635,95％CI:1.021～6.307)、무골이외기관전이(HR:2.323,95％CI:1.003～6.221).고위조23례,중위OS위16개월,저위조22례,중위OS위22개월,량조비교차이유통계학의의(P＜0.05). 결론 원발조절제、무골이외기관전이、진단신암시무골전이시신암골전이환자파향약물치료예후적유리인소.
Objective To investigate the prognostic related factors in patients with renal cell carcinoma(RCC) and bone metastases,treated by targeted therapy.Methods Forty-five patients with RCC and osseous metastases were treated by targeted therapy between June 2006 and April 2013.The mean age was 59 years (range 32-81 years) with 33 male cases and 12 female cases.Twenty-seven cases were diagnosed as RCC accompanied with bone metastases initially,and the median time between the diagnosis of RCC and that of osseous metastasis for the other 18 cases was 12.5 months.All the cases underwent target therapy with sorafenib in 38 cases and sunitinib in 7 cases.Data was retrospectively analyzed and the relationship between several clinical features and overall survival (OS) was examined univariately.The Cox proportional hazards model was then performed multivariately to identify the independent risk factors.According to the independent risk factors,RCC patients with osseous metastases were categorized into high risk group (≤ 1 favorable factors) and low risk group (＞ 1 favorable factors).The median OS in those groups was compared.Results The median OS from the diagnosis of bone metastasis was 19 months,and overall survival was 74.7％ at 1 year,and 32.7％ at 2 year.Clinical features correlated with longer survival in the multivariate analysis were the absence of osseous metastases when initially diagnosed as RCC (HR:2.401,95％CI:1.210-5.699),the resection of primary renal tumor (HR:2.635,95％CI:1.021-6.307) and the absence of extraosseous metastases (HR:2.323,95％CI:1.003-6.221).The median OS of high risk group in 23 patients was 16months.On the other hand,22 patients in the low risk group had a longer median OS with 22 months.There was a significant difference in median OS between the two groups (P＜0.05).Conclusions The three prognostic factors including the absence of osseous metastases when initially diagnosed as RCC,the resection of primary renal tumor and the absence of extraosseous metastases could be favorable factors for RCC patients with bone metastasis treated with target therapy.