利用患者特异性特征和竞争风险调整肾细胞癌术后监测成像的持续时间

Suzanne B. Merrill, Ahmad Alzubaidi, Eric Schaefer, V. Master, Dattatraya Patil, G. Allen, E. J. Abel, Jay D. Raman
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引用次数: 0

摘要

肾细胞癌(RCC)手术切除后的适当随访时间仍未完全确定。为了更好地了解这一时间线,我们调查了个人的RCC复发风险何时变得比非RCC死亡风险更小。 我们确定了 1999 年至 2018 年期间接受 M0 RCC 手术的 1672 例患者。根据病理分期、组织学、年龄和东部合作肿瘤学组(ECOG)表现状态对患者进行了分层。采用Fine和Gray模型估算了RCC复发和非RCC死亡的累积发生率函数。随访时间以非RCC死亡累积发生率超过RCC复发累积发生率的时间点来估算。 中位随访时间为 2.1 年(IQR 0.6-5.1 年),共有 272 例复发(16.3%)和 234 例非 RCC 死亡(14.0%)。拟合模型显示,分期与RCC复发、年龄和ECOG与非RCC死亡有明显关联。对于 50 岁的 pT1aN0-x 透明细胞且 ECOG 为 0 的患者,4.4 年后非 RCC 死亡的发生率超过了复发的发生率。但是,如果这类患者的 ECOG 状态为 1 或 2 至 4,则非 RCC 死亡发生率超过了 30 天后的复发率,这表明常规肿瘤监测可能没有必要。另外,无论 ECOG 状况如何,在所有年龄大于 pT3aN0-x 透明细胞的 50 岁患者中,非 RCC 死亡的发生率在大于 13.9 年的时间内都没有超过复发的发生率,因此建议进行比目前建议更长时间的监测。 RCC复发和非RCC死亡的竞争风险建模提供了特定患者何时可以合理停止随访的估计值。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Utilization of Patient-Specific Characteristics and Competing Risks to Tailor the Duration of Surveillance Imaging After Surgery for Renal Cell Carcinoma
The appropriate duration of follow-up after surgical resection of renal cell carcinoma (RCC) remains incompletely defined. To better inform on this time line, we investigate when an individual's risk of RCC recurrence becomes less significant than their risk of non-RCC death. We identified 1672 patients who underwent surgery for M0 RCC between 1999 and 2018. Patients were stratified by pathologic stage, histology, age, and Eastern Cooperative Oncology Group (ECOG) performance status. Cumulative incidence functions were estimated for RCC recurrence and non-RCC death using Fine and Gray models. Follow-up durations were estimated as the time point at which the cumulative incidence of non-RCC death exceeded that of RCC recurrence. At a median follow-up of 2.1 years (IQR 0.6-5.1 years), a total of 272 recurrences (16.3%) and 234 non-RCC deaths (14.0%) occurred. The fitted model showed significant associations of stage with RCC recurrence and of age and ECOG with non-RCC death. For 50-year-old patients with pT1aN0-x clear cell and ECOG 0, the incidence of non-RCC death exceeded that of recurrence after 4.4 years. However, if such patients had an ECOG status of 1 or 2 to 4, the incidence of non-RCC death exceeded that of recurrence at 30 days, suggesting that routine oncologic surveillance may not be necessary. Alternatively, regardless of ECOG status, the incidence of non-RCC death failed to exceed that of recurrence for >13.9 years in all patients age 50 with > pT3aN0-x clear cell thereby suggesting longer surveillance than currently recommended. Modeling competing risks of RCC recurrence and non-RCC death provide patient-specific estimates when follow-up may be reasonably discontinued.
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