中华泌尿外科杂志
中華泌尿外科雜誌
중화비뇨외과잡지
CHINESE JOURNAL OF UROLOGY
2015年
1期
7-11
,共5页
赵菊平%何竑超%王浩飞%祝宇%王晓晶%周文龙%沈周俊
趙菊平%何竑超%王浩飛%祝宇%王曉晶%週文龍%瀋週俊
조국평%하횡초%왕호비%축우%왕효정%주문룡%침주준
转移性肾癌%靶向治疗%预后因素%首月相对剂量密度
轉移性腎癌%靶嚮治療%預後因素%首月相對劑量密度
전이성신암%파향치료%예후인소%수월상대제량밀도
Metastatic renal cell carcinoma%Targeted therapy%Prognostic factor%Relative dose intensity in the first month
目的 探讨影响舒尼替尼治疗转移性肾癌的预后因素. 方法 回顾性分析2008年5月至2012年12月82例接受舒尼替尼治疗的转移性肾癌患者的临床资料,男60例,女22例.年龄29～ 82岁,平均(56.1±11.3)岁.52例有血尿、腰痛、肿块等临床症状.肿瘤大小2.0～18.0 cm,平均(8.0±3.0) cm.肾肿瘤位于左侧41例,右侧37例,双侧4例.69例接受了肾切除术,13例未行肾切除术者行穿刺活检获得病理.病理诊断为透明细胞癌75例,乳头状癌、嫌色细胞癌、肉瘤样癌各2例,集合管癌1例.转移部位包括肺50例、肝11例、骨14例、胰腺3例、后腹膜淋巴结31例.美国东部肿瘤协作组(eastern cooperative oncology group,ECOG)评分1～2分52例,≥3分30例.Hb平均(132±24) g/L,治疗开始时59例低于正常值.碱性磷酸酶平均(90±65) U/L,治疗开始时9例异常.乳酸脱氢酶平均(168±114) U/L,治疗开始时6例异常者.WBC平均为(6.4±2.0)×109/L,治疗开始时2例异常.MSKCC风险模型高危组14例,中危组68例.74例在确诊1年内、8例在确诊1年后接受舒尼替尼治疗,59例治疗首月相对剂量密度≥50％.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因素. 结果 本组82例的总生存期为2.8264.1个月,平均(21.6±14.1)个月.Kaplan-Meier生存分析结果显示,1年存活率为71％,2年存活率为64％,3年存活率为58％.单因素分析结果显示ECOG评分≥2分(P=0.005)、初次就诊时有临床症状(P=0.031)、未行患肾切除术(P=0.012)、转移部位数目≥2个(P=0.015)、靶向治疗开始时的Hb值(P=0.005)、靶向治疗开始时的碱性磷酸酶值(P=0.007)、MSKCC评分≥3分(P=0.000)、肝转移(P=0.000)、骨转移(P=0.000)、舒尼替尼首月相对剂量密度＜50％(P=0.000)等10项因素对转移性肾癌的预后有影响.Cox多因素分析结果显示ECOG评分≥2分(P=0.136)、初诊时无临床症状(P=0.801)、靶向治疗开始时碱性磷酸酶值＜126 U/L(P=0.618)、无骨转移(P=0.068)、无胰腺转移(P=0.265)等是对预后有益的因素;舒尼替尼首月相对剂量密度≥50％(P=0.000)是影响转移性肾癌预后的独立因素. 结论 靶向药物可使影响转移性肾癌预后的因素发生一定变化.舒尼替尼首月相对剂量密度≥50％是影响转移性肾癌预后的独立因素.
目的 探討影響舒尼替尼治療轉移性腎癌的預後因素. 方法 迴顧性分析2008年5月至2012年12月82例接受舒尼替尼治療的轉移性腎癌患者的臨床資料,男60例,女22例.年齡29～ 82歲,平均(56.1±11.3)歲.52例有血尿、腰痛、腫塊等臨床癥狀.腫瘤大小2.0～18.0 cm,平均(8.0±3.0) cm.腎腫瘤位于左側41例,右側37例,雙側4例.69例接受瞭腎切除術,13例未行腎切除術者行穿刺活檢穫得病理.病理診斷為透明細胞癌75例,乳頭狀癌、嫌色細胞癌、肉瘤樣癌各2例,集閤管癌1例.轉移部位包括肺50例、肝11例、骨14例、胰腺3例、後腹膜淋巴結31例.美國東部腫瘤協作組(eastern cooperative oncology group,ECOG)評分1～2分52例,≥3分30例.Hb平均(132±24) g/L,治療開始時59例低于正常值.堿性燐痠酶平均(90±65) U/L,治療開始時9例異常.乳痠脫氫酶平均(168±114) U/L,治療開始時6例異常者.WBC平均為(6.4±2.0)×109/L,治療開始時2例異常.MSKCC風險模型高危組14例,中危組68例.74例在確診1年內、8例在確診1年後接受舒尼替尼治療,59例治療首月相對劑量密度≥50％.採用Kaplan-Meier生存分析法計算患者的生存率,log-rank檢驗生存率差異,應用Cox比例迴歸風險模型分析影響預後的因素. 結果 本組82例的總生存期為2.8264.1箇月,平均(21.6±14.1)箇月.Kaplan-Meier生存分析結果顯示,1年存活率為71％,2年存活率為64％,3年存活率為58％.單因素分析結果顯示ECOG評分≥2分(P=0.005)、初次就診時有臨床癥狀(P=0.031)、未行患腎切除術(P=0.012)、轉移部位數目≥2箇(P=0.015)、靶嚮治療開始時的Hb值(P=0.005)、靶嚮治療開始時的堿性燐痠酶值(P=0.007)、MSKCC評分≥3分(P=0.000)、肝轉移(P=0.000)、骨轉移(P=0.000)、舒尼替尼首月相對劑量密度＜50％(P=0.000)等10項因素對轉移性腎癌的預後有影響.Cox多因素分析結果顯示ECOG評分≥2分(P=0.136)、初診時無臨床癥狀(P=0.801)、靶嚮治療開始時堿性燐痠酶值＜126 U/L(P=0.618)、無骨轉移(P=0.068)、無胰腺轉移(P=0.265)等是對預後有益的因素;舒尼替尼首月相對劑量密度≥50％(P=0.000)是影響轉移性腎癌預後的獨立因素. 結論 靶嚮藥物可使影響轉移性腎癌預後的因素髮生一定變化.舒尼替尼首月相對劑量密度≥50％是影響轉移性腎癌預後的獨立因素.
목적 탐토영향서니체니치료전이성신암적예후인소. 방법 회고성분석2008년5월지2012년12월82례접수서니체니치료적전이성신암환자적림상자료,남60례,녀22례.년령29～ 82세,평균(56.1±11.3)세.52례유혈뇨、요통、종괴등림상증상.종류대소2.0～18.0 cm,평균(8.0±3.0) cm.신종류위우좌측41례,우측37례,쌍측4례.69례접수료신절제술,13례미행신절제술자행천자활검획득병리.병리진단위투명세포암75례,유두상암、혐색세포암、육류양암각2례,집합관암1례.전이부위포괄폐50례、간11례、골14례、이선3례、후복막림파결31례.미국동부종류협작조(eastern cooperative oncology group,ECOG)평분1～2분52례,≥3분30례.Hb평균(132±24) g/L,치료개시시59례저우정상치.감성린산매평균(90±65) U/L,치료개시시9례이상.유산탈경매평균(168±114) U/L,치료개시시6례이상자.WBC평균위(6.4±2.0)×109/L,치료개시시2례이상.MSKCC풍험모형고위조14례,중위조68례.74례재학진1년내、8례재학진1년후접수서니체니치료,59례치료수월상대제량밀도≥50％.채용Kaplan-Meier생존분석법계산환자적생존솔,log-rank검험생존솔차이,응용Cox비례회귀풍험모형분석영향예후적인소. 결과 본조82례적총생존기위2.8264.1개월,평균(21.6±14.1)개월.Kaplan-Meier생존분석결과현시,1년존활솔위71％,2년존활솔위64％,3년존활솔위58％.단인소분석결과현시ECOG평분≥2분(P=0.005)、초차취진시유림상증상(P=0.031)、미행환신절제술(P=0.012)、전이부위수목≥2개(P=0.015)、파향치료개시시적Hb치(P=0.005)、파향치료개시시적감성린산매치(P=0.007)、MSKCC평분≥3분(P=0.000)、간전이(P=0.000)、골전이(P=0.000)、서니체니수월상대제량밀도＜50％(P=0.000)등10항인소대전이성신암적예후유영향.Cox다인소분석결과현시ECOG평분≥2분(P=0.136)、초진시무림상증상(P=0.801)、파향치료개시시감성린산매치＜126 U/L(P=0.618)、무골전이(P=0.068)、무이선전이(P=0.265)등시대예후유익적인소;서니체니수월상대제량밀도≥50％(P=0.000)시영향전이성신암예후적독립인소. 결론 파향약물가사영향전이성신암예후적인소발생일정변화.서니체니수월상대제량밀도≥50％시영향전이성신암예후적독립인소.
Objective To study the prognostic factors of survival in patients with metastatic renal cell carcinoma (mRCC) treated with sunitinib.Methods From May 2008 to Dec 2012,the clinical data of 82 cases with mRCC adminstered by sunitinib were reviewed retrospectively.The study included 60 male patients and 22 female patients,whose age ranged from 29 to 82 years [mean (56.1±11.3) years].Among them,52 cases presented hematuria,flank pain and palpable mass.The size of renal tumor ranged from 2.0 to 18.0 cm [mean (8.0±3.0) cm].The location of tumor included 41 in left kidney,37 in right kidney and 4 in bilateral kidney.The pathological tissue obtained from the operation in 69 cases and from biopsy in 13 cases.The pathological results demonstrated renal cell carcinoma in 75 cases,papillary cell carcinoma in 2 cases,chromophobe cell carcinoma in 2 cases,sarcomatoid carcinoma in 2 cases,collecting duct carcinoma in one case.The site of metastasis included lung in 50 cases,liver in 11 cases,bone in 14 cases,pancrease in 3 cases,retroperitoneal lymph node in 31 cases.In 52 cases,the ECOG scores ranged from 1 to 2.The others scores were more than 3.The average level of hemoglobin,AKP,LDH and leukocyte were (132±24)g/L,(90±65) U/L,(168±114) U/L and (6.4±2.0)×109/L,respectively.Before treatment,the abnormal cases in those parameters were 59,9,6 and 2,respectively.According to the MSKCC risk model,14 cases were classified into the high risk group and 68 cases into medium risk group.74 cases were accepted the sunitinb therapy within one year after diagnosis and 8 cases were accepted same therapy until one year after diagnosis.The overall survival (OS) rates were calculated by Kaplan-Meier method and Cox regression model was used to analyze the relationship between the influencing factors and the prognosis.Results The average OS was (21.6± 14.1) months (ranged 2.8 to 64.1 months).The survival rate at 1 st,2nd and 3rd year were 71％,64％ and 58％,respectively.Single factor analysis showed that significant prognostic factors were as follows:ECOG performance status ≥ 2 (P =0.005),clinical symptom during first clinic visiting (P =0.031),without nephrectomy (P =0.012),the number of metastatic sites ≥ 2 (P =0.015),hemoglobin before treatment (P=0.005),serum AKP level before treatment (＞126 U/L) (P=0.007),MSKCC score≥ 3 (P =0.000),the presence of liver metastases (P =0.000) and bone metastases (P =0.000) and relative dose intensity in the first month (1M-RDI) of sunitinib ≥ 50％ (P=0.000).Cox regression model showed that the beneficial predictive factors were ECOG performance status＜2 (P=0.136),no symptom during the first clinic visiting (P=0.801),serum AKP ＜126 U/L (P=0.618) before treatment,the absence of bone (P =0.068) and pancreas metastases (P =0.265).Sunitinib 1M-RDI ≥ 50％ was the independent predictive factor (P=0.000).Conclusions In targeted therapy era,there is some change in the prognostic factors for mRCC and target drug play an important role in the prognosis of mRCC.Sunitinib 1M-RDI ≥50％ is the independent predictive factor for the prognosis of renal carcinoma.
