探究原发灶减瘤术对肾细胞癌合并骨转移患者的生存获益  

To investigate the survival benefit of primary tumor reduction surgery in patients with renal cell carcinoma and bone metastasis

作　　者：韩超[1] 王立东 张璐琛 王艺臻 HAN Chao;WANG Li-dong;ZHANG Lu-chen(Department of Urology,Affiliated Qingdao Central Hospital of Qingdao University,Qingdao Cancer Hospital,Shandong 266042,China)

机构地区：[1]青岛大学附属青岛市中心医院泌尿外科,山东青岛266042 [2]诸城慈海中西医结合医院外科,山东潍坊262299

出　　处：《中日友好医院学报》2023年第5期267-271,276,F0003,共7页Journal of China-Japan Friendship Hospital

摘　　要：目的:探究原发灶减瘤术对肾细胞癌合并骨转移患者的生存获益情况。方法:分析2006年—2018年期间SEER数据库中的肾细胞癌合并骨转移患者的临床数据,根据是否行减瘤手术进行分组,比较组间的差异。通过倾向性匹配分析,降低组间基线差异,Kaplan-Meier法绘制生存曲线分析各组的生存情况,采用单因素和多因素Cox比例风险回归模型分析与肾细胞癌合并骨转移患者相关的预后影响因素。结果:从数据库中提取607例患者的数据,通过倾向性匹配后,纳入134例患者。Grade分级、肾癌病理类型、是否行减瘤手术、脑转移肺转移,均是肾癌合并骨转移肿瘤患者总体生存期和特异性生存期的独立风险因素。减瘤组1、3年总生存(OS)率分别为65.81%、35.90%;未减瘤组1、3年OS率分别为40.10%、15.84%,2组间差异有统计学意义(P<0.05)。Kaplan-Meier生存曲线显示减瘤组较未行减瘤术组预后较好且有统计学意义(P<0.05),肾透明细胞癌合并骨转移患者的预后明显优于乳头状肾细胞癌合并骨转移。结论:原发灶减瘤术总体上可以延长肾细胞癌合并骨转移患者的生存时间,改善患者预后。Objective:To explore the survival benefit of tumor cytoreductive nephrectomy in renal cell carcino-ma patients with bone metastasis(RCC-BM).Methods:Clinical data of patients with RCC-BM from the Seer Database between 2006 and 2018 were analyzed and grouped according to whether or not cytoreductive ne-phrectomy was performed,and differences between groups were compared.By propensity matching,the baseline differences between groups were reduced,and survival curves were drawn by Kaplan-Meier method to analyze the survival of each group.Univariate and multivariate Cox proportional hazards regression models were used to analyze the prognostic factors associated with RCC-BM.Results:Data of 607 patients were extracted from the database.By propensity matching,134 patients were included.Grade,pathological type of renal cell carcino ma,whether to undergo subtractive surgery,brain and lung metastases were independent risk factors for the overall survival and cancer-specific survival of patients with RCC-BM.The prognosis of the cytoreductive ne-phrectomy group was better than that of the non-cytoreductive nephrectomy group,and the prognosis of the renal clear cell carcinoma with bone metastasis group was better than that of the papillary renal cell carcino-ma with bone metastasis.Conclusion:Cytoreductive nephrectomy surgery can prolong the survival time and im-prove the prognosis of RCC-BM.

关 键 词：肾癌 骨转移 减瘤术 SEER 预后 

分 类 号：R737.1[医药卫生—肿瘤]