肾细胞癌骨转移病灶分布特征与生存预后的关系  

Association of bone lesions distribution with prognosis in renal cell carcinoma bone metastasis

作　　者：黄子雄 于路平[1] 张晓鹏[1] 李清[1] 刘士军[1] 徐涛[1] Huang Zixiong;Yu Luping;Zhang Xiaopeng;Li Qing;Liu Shijun;Xu Tao(Department of Urology,Peking University People’s Hospital,Beijing 100044,China)

机构地区：[1]北京大学人民医院泌尿外科,北京100044

出　　处：《中华泌尿外科杂志》2023年第7期486-491,共6页Chinese Journal of Urology

基　　金：北京大学人民医院研究与发展基金资助项目(RDY2021-20)。

摘　　要：目的探讨肾细胞癌骨转移病灶的分布特征与患者生存预后的关系。方法回顾性分析2009年1月至2019年12月北京大学人民医院收治的122例肾细胞癌骨转移患者的临床资料。男100例,女22例;年龄(59.87±11.33)岁。根据纪念斯隆-凯特琳癌症中心(MSKCC)/Motzer评分体系,首次诊断骨转移时20例(16.4%)为预后低风险组,74例(60.6%)为中风险组,28例(23.0%)为高风险组。首次诊断骨转移时,26例(21.3%)处于局限骨转移组(转移灶仅累及胸椎和/或腰椎),69例(56.6%)处于随机骨转移组(转移灶仅累及骨,但存在除胸腰椎外的病灶),27例(22.1%)处于广泛转移组(合并其他器官转移);48例(39.3%)病灶累及脊柱,43例(35.2%)累及骨盆,22例(18.0%)累及上肢,20例(16.4%)累及下肢。同时性转移(初次诊断肾细胞癌时即发现骨转移)61例;异时性骨转移(诊断肾细胞癌手术后随访发现骨转移)61例。诊断肾细胞癌后,99例(81.1%)接受根治性肾切除术,6例(4.9%)接受肾部分切除术,其余患者(17例,13.9%)接受肿瘤消融、栓塞等治疗。82例(67.2%)接受骨转移灶确定性手术(转移灶整块切除、病灶内刮除),40例(32.8%)接受姑息性减瘤手术(含椎体成形术、椎管减压术、内固定术、射频消融术)。32例(26.2%)接受靶向药物或免疫检查点抑制剂治疗,12例(9.8%)接受针对骨转移灶的局部放疗。记录患者随访期间骨转移病灶分布特征。使用单因素分析、Kaplan-Meier生存分析和有序多分类logistic回归,分析骨转移病灶总体分布、累及部位特征与预后风险分级、总体生存时间的关系。结果首次诊断骨转移时局限骨转移组患者处于预后高风险组的比例(30.8%,8/26)略高于非局限骨转移组(随机骨转移及广泛转移组,20.8%,20/96),但差异无统计学意义(P=0.107)。调整一般资料、骨转移累及部位、合并其他器官转移因素后,有序多分类logistic回归分析结果显示,首次诊断骨转移时病灶�Objective To investigate the association between bone lesions distribution and survival outcome and prognostic risk stratification in renal cell carcinoma bone metastasis(RCC-BM).Methods The data of 122 RCC-BM patients admitted to Peking University People's Hospital between January 2009 and December 2019 were retrospectively reviewed.There were 100 males and 22 females,with a baseline age of(59.87±11.33)years old.According to the Memorial Sloan-Kettering Cancer Center(MSKCC)/Motzer score,patients were stratified into different risk groups using profiles at first bone metastasis diagnosis,with 20(16.4%),74(60.6%)and 28(23.0%)patients in favorable,intermediate and poor group,respectively.The spatial distribution of bone metastasis was investigated at the first bone metastasis diagnosis.The overall distribution patterns were as follows:locoregional group(lesions only involved thoracic and/or lumbar vertebrates)in 26 cases(21.3%),stochastic group(bone lesions randomly distributed)in 69 cases(56.6%),extensive group(with concomitant visceral metastasis)in 27 cases(22.1%).Metastatic site involvement was as follows:spine in 48 cases(39.3%),pelvis in 43 cases(35.2%),upper extremities in 22 cases(18.0%),and lower extremities in 20 cases(16.4%).Half(61 cases)of the enrolled patients had synchronous bone metastasis as their first bone metastases were diagnosed simultaneously with their renal tumors.Of all the patients,99(81.1%)accepted radical nephrectomy,6(4.9%)accepted partial nephrectomy,and the other 17 patients(13.9%)accepted the treatment of ablation or embolization.Eighty-two patients(67.2%)received definitive treatment for bone metastatic lesions,respectively.Forty patients(32.8%)accepted the palliative tumor reduction therapy.Thirty-two patients(26.2%)received tyrosine kinase inhibitor(TKI)or immune checkpoint inhibitor(ICI)medication,and 12 patients(9.8%)received local radiotherapy.Distribution variation and therapeutic strategies throughout the disease course until the last follow-up were recorded.Univariate anal

关 键 词：癌 肾细胞 骨转移 病灶分布 预后风险分层 

分 类 号：R737.11[医药卫生—肿瘤]