目的:基于监测评价肾细胞癌(RCC)患者肺转移的危险因素及预后。流行病学,和结束结果(SEER)数据库。
方法:从SEER数据库中选择56,617例RCC患者。基于单变量和多变量逻辑回归,我们得出了发生肺转移的危险因素.2906例患者最初被诊断为肺转移,然后用于研究预后因素。多变量Cox回归分析用于预测癌症特异性死亡率。
结果:总计,2906例RCC患者最初诊断为肺转移。RCC中肺转移的患病率约为5%,生存率低。衰老,男性,其他种族(美洲印第安人/AK本地人,亚太岛民)无保险身份,双侧肿瘤,收集管道,较高的T阶段,局部淋巴结转移,肿瘤等级更高,其他远处转移的证据与诊断时发生肺转移显著相关。年龄>70岁,黑色,女性,双侧肿瘤,T4阶段,肿瘤等级更高,局部淋巴结转移,收集管道,还有骨头的证据,肝脏,或脑转移与较高的死亡风险相关。在粗和校正逻辑回归中,黑人和女性在诊断时发生肺转移的几率较低。同时,在Cox回归分析中,黑人和女性的死亡率高于白人和男性.
结论:揭示了与肺转移的发展和预后有关的几个因素,尤其是黑人和女性在初次诊断时发生肺转移性RCC的风险较低,但死亡风险较高.这些可能为肾细胞癌患者的肺转移的筛查和治疗提供预防指南。
OBJECTIVE: To evaluate risk factors and prognosis of lung metastases in patients with renal cell carcinoma (RCC) based on the Surveillance, Epidemiology, and End Results (SEER) database.
METHODS: 56,617 patients with RCC were selected from the SEER database. Based on univariate and multivariate logistic regression, the risk factors for developing lung metastases were derived. 2906 patients were initially diagnosed with lung metastases, and then were used to research the prognostic factors. Multivariable Cox regression analyses were performed for the prediction of cancer-specific mortality.
RESULTS: In total, 2906 RCC patients were initially diagnosed with lung metastases. The prevalence of lung metastases in RCC was approximately 5% with poor survival. Aging, male, other race (American Indian/AK native, Asian Pacific islander) uninsured status, bilateral tumor, collecting duct, higher T stage, local lymph node metastases, higher tumor grade, and evidence of other distant metastases were significantly associated with developing lung metastases at diagnosis. Age >70 years-old, black, female, bilateral tumor, T4 stage, higher tumor grade, local lymph node metastases, collecting duct, and evidence of bone, liver, or brain metastases were related to higher risk of mortality. Blacks and female have lower odds of developing lung metastases at the time of diagnosis both in crude and adjusted logistic regression. Meanwhile, blacks and female showed higher risk of mortality compared with whites and male in Cox regression analyses.
CONCLUSIONS: Several factors related to the development and prognosis of lung metastases were revealed, especially black people and female gender have lower risk of developing lung metastatic RCC at initial diagnosis but have higher risk of mortality. These may provide preventive guidelines for the screening and treatment of lung metastases in patients with renal cell carcinoma.