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目的：拟应用大数据库样本探讨原发灶减瘤术(CN)对老年(年龄≥60岁)转移性肾透明细胞癌(mccRCC)患者预后的影响。方法：收集2010年至2015年间SEER数据库中年龄≥60岁的转移性肾透明细胞癌患者，纳入符合研究条件的1 614例患者进行回顾性分析研究，根据其是否实施CN分为减瘤组与未减瘤组。利用X-tile软件进行年龄影响患者预后的截断值分析。利用Kaplan-Meier生存分析绘制生存曲线并比较两组的生存情况，采用COX风险回归模型，分析影响老年mccRCC患者的独立预后因素并进行亚组分析。结果：Kaplan-Meier生存曲线显示减瘤组预后较好且有统计学意义(χ2=325.00,P<0.001)。COX多因素分析结果显示，年龄、T分期、N分期、手术、肝转移、肺转移、脑转移、骨转移是影响患者生存的独立预后因素(P<0.05)。而种族、性别、放疗、化疗不是影响患者生存的独立预后因素(P>0.05)。亚组分析显示CN为OS的独立保护因素。结论：原发灶减瘤术总体上可以延长老年转移性肾透明细胞癌患者的生存时间，改善患者预后。
Abstract：Objective:To investigate the effect of cytoreductive nephrectomy(CN)on the prognosis of elderly patients(age ≥60 years)with metastatic clear cell renal cell carcinoma(mccRCC)using a large database sample.Methods:Data from mccRCC patients aged ≥60 years registered in the SEER database between2010 and 2015 were retrieved.A total of 1614 eligible patients were included for this retrospective analysis,and were assigned to the cytoreductive and non-cytoreductive groups according to whether they underwent CN.X-tile software was used to analyze the cut-off value of age affecting the patient prognosis.Kaplan-Meier survival analysis was used to generate a survival curve for comparison on the survival of the two groups.COX regression hazard model was used to determine the independent prognostic factors affecting elderly mccRCC patients and to perform the subgroup analyses.Results:The Kaplan-Meier survival curve showed favorable prognosis in the cytoreductive group with statistical significance(χ2= 325.00,P<0.001).COX multivariate analysis showed that age,T and N staging,surgical option,metastases to the liver,lung,brain,and bone,were independent prognostic factors affecting the patient survival(P<0.05),but not the ethnicity,gender,radiotherapy and chemotherapy(P>0.05).Subgroup analyses showed that CN was an independent protective factor for overall survival.Conclusion:Cytoreductive nephrectomy can prolong the overall survival and improve the prognosis of elderly patients with mccRCC.
[1] Siegel RL,Miller KD,Fuchs HE,et al. Cancer statistics,2021[J]. CA Cancer J Clin,2021,71(1):7-33.
[2] Sung H,Ferlay J,Siegel RL,et al. Global cancer statistics2020:GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin,2021,71(3):209-249.
[3] Bai X,Yi M,Dong B,et al. The global,regional,and national burden of kidney cancer and attributable risk factor analysis from 1990 to 2017[J]. Exp Hematol Oncol,2020,9(1):27.
[4] Hsieh JJ, Purdue MP, Signoretti S, et al. Renal cell carcinoma[J]. Nat Rev Dis Primers,2017,3:17009.
[5] Flanigan RC,Yonover PM.The role of radical nephrectomy in metastatic renal cell carcinoma[J]. Semin Urol Oncol,2001,19(2):98-102.
[6] Heng DY, W ells JC, Rini BI, et al. Cytoreductive nephrectomy in patients with synchronous metastases from renal cell carcinoma:results from the International Metastatic Renal Cell Carcinoma Database Consortium[J].Eur Urol,2014,66(4):704-710.
[7]杨津，柳青青，耿辉，等．SEER数据库的申请及数据提取方法与流程[J]．中国循证心血管医学杂志，2018,10(7):781-784.
[8] Dekernion JB,Ramming KP,Smith RB.The natural history of metastatic renal cell carcinoma:a computer analysis[J].J Urol,1978,120(2):148-152.
[9] Kapoor A, Kim J, Goucher G, et al. Evolving role of urologists in the management of advanced renal cell carcinoma[J]. Urol Clin North Am,2020,47(3):271-280.
[10] Bex A,Albiges L,Ljungberg B,et al. Updated european association of urology guidelines for cytoreductive nephrectomy in patients with synchronous metastatic clearcell renal cell carcinoma[J]. Eur Urol,2018,74(6):805-809.
[11] Laru L,Ronkainen H,Ohtonen P,et al. Nephrectomy improves the survival of metastatic renal cell cancer patients with moderate to good performance status-results from a Finnish nation-wide population-based study from2005 to 2010[J]. World J Surg Oncol,2021,19(1):190.
[12] A rora S, Sood A, D alela D, et al. Cytoreductive nephrectomy:assessing the generalizability of the CARMENA trial to real-world national cancer data base cases[J]. Eur Urol,2019,75(2):352-353.
[13] Tatsumi T, Herrem CJ, Olson WC, et al. Disease stage variation in CD4+and CD8+T-cell reactivity to the receptor tyrosine kinase EphA2 in patients with renal cell carcinoma[J]. Cancer Res,2003,63(15):4481-4489.
[14] Hanna N,Sun M,Meyer CP,et al. Survival analyses of patients with metastatic renal cancer treated with targeted therapy with or without cytoreductive nephrectomy:a national cancer data base study[J]. J Clin Oncol,2016,34(27):3267-3275.
[15] Daugherty M, Daugherty E, Jacob J, et al. Renal cell carcinoma and brain metastasis:Questioning the dogma of role for cytoreductive nephrectomy[J]. Urol Oncol,2019,37(3):182.e9-182.e15.
[16]王延东，罗光恒．转移性肾癌减瘤手术是有价值的[J]．现代泌尿外科杂志，2014,19(7):479-483.
[17]董毅，王林辉．转移性肾癌减瘤性肾切除术的指征该如何把握[J]．中华腔镜泌尿外科杂志（电子版），2019,13(5):289-292.
[18] Biles MJ,Patel HD,Allaf ME. Cytoreductive nephrectomy in the era of tyrosine kinase and immuno-oncology checkpoint inhibitors[J]. Urol Clin North Am,2020,47(3):359-370.
基本信息:
中图分类号:R737.11
引用信息:
[1]周园,郑建坤,郭立仪,等.基于SEER数据库探讨原发灶减瘤术对老年转移性肾透明细胞癌患者预后的影响[J].广州医科大学学报,2022,50(02):24-29.