单部位远处转移的肉瘤样肾细胞癌患者生存时间及特异性预后因素分析

Analysis of survival time and specific prognostic factors for patients with sarcomatoid renal cell carcino-ma with single-site of distant metastasis

目的评估单部位远处转移的肉瘤样肾细胞癌患者的生存时间,探讨不同部位转移患者的特异性预后影响因素。方法分析2006年至2018年期间SEER数据库中的肉瘤样肾细胞癌患者的临床数据,通过Kaplan-Meier法和Log-rank检验比较不同远处部位转移患者之间的总生存时间分布,通过单变量和多变量Cox比例风险回归模型分析与肉瘤样肾细胞癌患者总生存时间相关的预后影响因素。结果219例发生单部位远处转移的肉瘤样肾细胞癌患者中,肺转移128例(58.45%)、骨转移66例(30.14%)、肝转移18例(8.22%)、脑转移7例(3.19%)。发生肺、骨、肝、脑转移患者的中位总生存时间分别为5、6、3和5个月,差异无统计学意义(χ2=4.64,P>0.05)。年龄、手术、化疗是整体患者的独立预后影响因素(P<0.05),手术、化疗是肺转移患者的独立预后影响因素(P<0.05),手术是骨转移患者的独立预后影响因素(P<0.05)。结论对于发生单部位远处转移的肉瘤样肾细胞癌患者,其转移部位类型不影响患者的总生存时间,行原发肿瘤所在的肾切除术能降低肺转移、骨转移患者的死亡风险,化疗能降低肺转移患者的死亡风险,但未发现能降低骨转移患者的死亡风险。

Objective To assess the overall survival(OS)of sarcomatoid renal cell carcinoma(sRCC)with single-site of distant metastasis,and identify the prognostic factors for site-specific distant metastasis.Methods The clinical data of sRCC from the SEER database between 2006 and 2018 were analyzed.OS between different groups were compared by the Kaplan-Meier method and the Log-rank test,and prognostic factors associated with OS were identified by univariate and multivariate Cox proportional hazards models.Results Of the 219 patients with single-site of distant metastasis,128 had lung metastasis(58.45%),bone metastasis in 66 cases(30.14%),liver metastasis in 18 cases(8.22%),and brain metastasis in 7 cases(3.19%).The median OS of patients with lung,bone,liver,and brain metastasis were 5,6,3,and 5 months,respectively,with no significant difference(χ2=4.64,P>0.05).Age,surgery and chemotherapy were independent prognostic factors for all patients(P<0.05),surgery and chemotherapy were independent prognosis factors for patients with lung metastasis(P<0.05),and surgery was an independent prognosis factor for patients with bone metastasis(P<0.05).Conclusions For patients with single-site of distant metastasis,the specific type of distant metastatic site did not affect the OS.Nephrectomy reduced the risk of mortality in patients with lung and bone metastasis.Chemotherapy reduced the risk of mortality in patients with lung metastasis,but was not found to reduce the risk of mortality in patients with bone metastasis.