PDF(Pubmed)
Abstract：
Over the last decades, the therapeutic armamentarium of metastatic renal cell carcinoma (mRCC) has been revolutionized by the advent of tyrosin-kinase inhibitors (TKI), immune-checkpoint inhibitors (ICI), and immune-combinations. RCC is heterogeneous, and even the most used validated prognostic systems, fail to describe its evolution in real-life scenarios. Our aim is to identify potential easily-accessible clinical factors and design a disease course prediction system. Medical records of 453 patients with mRCC receiving sequential systemic therapy in two high-volume oncological centres were reviewed. The Kaplan-Meier method and Cox proportional hazard model were used to estimate and compare survival between groups. As first-line treatment 366 patients received TKI monotherapy and 64 patients received ICI, alone or in combination. The mean number of therapy lines was 2.5. A high Systemic Inflammation Index, a BMI under 25 Kg/m2, the presence of bone metastases before systemic therapy start, age over 65 years at the first diagnosis, non-clear-cell histology and sarcomatoid component were correlated with a worse OS. No significant OS difference was observed between patients receiving combination therapies and those receiving exclusively monotherapies in the treatment sequence. Our relapse prediction system based on pathological stage and histological grade was effective in predicting the time between nephrectomy and systemic treatment. Our multicentric retrospective analysis reveals additional potential prognostic factors for mRCC, not included in current validated prognostic systems, suggests a model for disease course prediction and describes the outcomes of the most common therapeutic strategies currently available.
摘要：
在过去的几十年里，酪氨酸激酶抑制剂（TKI）的出现彻底改变了转移性肾细胞癌（mRCC）的治疗方法，免疫检查点抑制剂（ICI），和免疫组合。碾压混凝土是异质的，甚至是最常用的验证预后系统，无法描述它在现实生活中的演变。我们的目标是确定潜在的易于获得的临床因素，并设计疾病病程预测系统。回顾了在两个高容量肿瘤中心接受序贯全身治疗的453例mRCC患者的病历。使用Kaplan-Meier方法和Cox比例风险模型来估计和比较组间的生存率。作为一线治疗，366名患者接受TKI单一疗法，64名患者接受ICI，单独或联合治疗。治疗线的平均数为2.5。高系统性炎症指数，BMI低于25Kg/m2，在全身治疗开始前存在骨转移，第一次诊断时年龄超过65岁，非透明细胞组织学和肉瘤样成分与OS较差相关.在接受组合疗法的患者和在治疗序列中接受仅单一疗法的患者之间没有观察到显著的OS差异。我们基于病理分期和组织学分级的复发预测系统可有效预测肾切除术和全身治疗之间的时间。我们的多中心回顾性分析揭示了mRCC的其他潜在预后因素，不包括在当前验证的预后系统中，提出了一个预测病程的模型，并描述了目前可用的最常见治疗策略的结果。
