转移型肉瘤样肾癌的生存分析研究及治疗进展

Survival analysis of patients with metastatic sarcomatoid renal cell carcinoma and treatment progress

目的:探究影响转移型肉瘤样肾癌(msRCC)患者预后的危险因素及治疗方案。方法:回顾分析SEER数据库的413例msRCC患者的临床资料。采用Kaplan-Meier生存分析计算总体生存率(OS)及肿瘤特异性生存率(CSS),对随访数据进行COX多因素回归分析,分析因素包括婚姻状态、年龄、种族、性别、肿瘤侧别、Grade分级、Fuhrman核分级、肿瘤大小、区域淋巴结转移、远处转移灶、原发肿瘤的局部浸润、肿瘤原发灶手术方式、区域淋巴结清扫情况、放化疗。结果:研究发现,msRCC患者的5年OS约为3.7%,5年CSS约为4.3%。COX多因素回归发现,年龄>70岁、区域淋巴结转移、肝转移、肺转移作为影响预后的独立危险因素;而肾切除术(包括根治切除)、化疗则作为预后保护因素。对于存在骨、肝、肺或多发器官转移的msRCC患者,采取减瘤性肾切除术可显著改善预后。结论:msRCC的恶性程度极高,患者预后不良,常规治疗不敏感,研究发现采取减瘤性肾切除术及化疗可改善msRCC患者预后。近年来发现PD-1/PD-L1在sRCC患者存在的高表达特性,未来PD-1/PD-L1抑制剂可能将作为msRCC的一线治疗。

Objective:To investigate the independent prognostic factors for metastatic sarcomatoid renal cell carcinoma(msRCC)and the progress on treatment.Method:Clinical data from a cohort of 413 msRCC patients were collected from 2010 to 2016 based on the SEER database.Overall survival(OS)and cancer-specific survival(CSS)were calculated using the Kaplan-Meier method.The COX regression model was utilized to analyze factors(including marital status,age,race,sex,laterality,tumor grade,Fuhrman nuclear grade,tumor size,regional lymph node,metastatic disease,tumor invasion,surgery of primary tumor,surgery of regional lymph node,radiotherapy and chemotherapy)influencing patient prognosis.Result:As discovered when analyzing the research data,the five-year OS and five-year CSS were 3.7%and 4.3%for msRCC patients,respectively.Besides,COX regression analysis showed that age>70 years,regional lymph node metastasis,liver metastasis and lung metastasis were the independent risk factors for survival prognosis,whereas nephrectomy(including radical nephrectomy)and chemotherapy were the protective factors.In addition,cytoreductive nephrectomy was suggested to improve the prognosis for msRCC patients with bone,liver,lung or multiple organ metastases.Conclusion:MsRCC is associated with a high malignant grade and poor patient prognosis,and these patients are often insensitive to routine treatment.Based on our results,the prognosis for msRCC patients can be improved by cytoreductive nephrectomy and chemotherapy.The existing biomarker studies suggest that PD-1/PD-L1 is up-regulated in sRCC,and PD-1/PD-L1 inhibitors may serve as the first-line treatment for msRCC in the future.