采用基于免疫检查点抑制剂的一线联合疗法治疗转移性肾细胞癌患者时，同步转移与非同步转移对疗效的影响

IF 4.8 2区医学 Q1 UROLOGY & NEPHROLOGY

European urology focus Pub Date : 2024-04-04 DOI:10.1016/j.euf.2024.03.006

Georges Gebrael, Luis Meza, Xiaochen Li, Zeynep Zengin, Nicolas Sayegh, Hedyeh Ebrahimi, Nishita Tripathi, Daniela Castro, Benjamin Mercier, Regina Barragan-Carrillo, Haoran Li, Alexander Chehrazi-Raffle, Umang Swami, Abhishek Tripathi, Neeraj Agarwal, Benjamin L. Maughan, Sumanta K. Pal

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引用次数: 0

摘要

在以免疫检查点抑制剂（ICI）为基础的联合用药时代，原发性肾细胞癌（RCC）诊断时的转移发生时间对生存结果的影响尚未得到很好的描述。在此，我们评估了同步转移性RCC（mRCC）和非同步转移性RCC（mRCC）临床结局的差异。我们回顾性地收集了2014年至2023年间接受基于ICI的一线联合疗法治疗的mRCC患者的数据。如果患者在RCC确诊后3个月内出现同步转移，则被归类为同步转移；如果在初诊后3个月以上出现转移，则被定义为同步转移。对治疗失败时间（TTF）、总生存期（OS）和疾病控制率（DCR）进行了评估。我们的分析包括 223 名符合条件的患者（126 名同步转移患者和 97 名非同步转移患者）。同步组和近交组的中位 TTF 无明显差异（9 个月 vs 19.8 个月；= 0.063）。同步组的中位生存期明显较短（28.0 月 vs 50.9 月；= 0.001）。同样，与远处转移相比，同步转移患者的 DCR 更低（58.7% vs. 78.4%; = 0.002）。在多变量分析中，同步转移仍然与较差的OS和DCR独立相关。在这项假设性研究中，接受基于 ICI 的一线联合疗法治疗的同步转移的 mRCC 患者的 OS 和 DCR 都比非同步转移的 mRCC 患者差。如果这些结果得到外部验证，转移时间可被纳入 mRCC 的预后模型中。我们的研究表明，接受目前一线免疫疗法治疗的患者，如果在肾癌初诊时出现转移，其总生存期会比后来出现转移的患者更差。这些结果有助于医生和患者了解预期寿命。

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Impact of Synchronous versus Metachronous Metastasis on Outcomes in Patients with Metastatic Renal Cell Carcinoma Treated with First-line Immune Checkpoint Inhibitor–based Combinations

The impact of time of metastasis onset with respect toprimary renal cell carcinoma (RCC) diagnosis on survival outcomes is not well characterized in the era of immune checkpoint inhibitor (ICI)-based combinations. Herein, we assessed differences in clinical outcomes between synchronous and metachronous metastatic RCC (mRCC). Data for patients with mRCC treated with first-line ICI-based combination therapies between 2014 and 2023 were retrospectively collected. Patients were categorized as having synchronous metastasis if present within 3 mo of RCC diagnosis; metachronous metastasis was defined as metastasis >3 mo after primary diagnosis. Time to treatment failure (TTF), overall survival (OS), and the disease control rate (DCR) were assessed. Our analysis included 223 eligible patients (126 synchronous and 97 metachronous). Median TTF did not significantly differ between the synchronous and metachronous groups (9 vs 19.8 mo; = 0.063). Median OS was significantly shorter in the synchronous group (28.0 vs 50.9 mo; = 0.001). Similarly, patients with synchronous metastasis had lower DCR compared to metachronous metastasis (58.7% vs. 78.4%; = 0.002). On multivariable analyses, synchronous metastasis remained independently associated with worse OS and DCR. In this hypothesis-generating study, patients with mRCC with synchronous metastasis who were treated with first-line ICI-based combinations have a poorer OS and worse DCR than those with metachronous mRCC. If these results are externally validated, time to metastasis could be included in prognostic models for mRCC. Our study demonstrates that patients treated with current first-line immunotherapies, who present with metastasis at the initial diagnosis of kidney cancer have worse overall survival compared to those who develop metastasis later. These results can help physicians and patients understand life expectancy.

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来源期刊

European urology focus Medicine-Urology

CiteScore

10.40

自引率

3.70%

发文量

274

审稿时长

23 days

期刊介绍： European Urology Focus is a new sister journal to European Urology and an official publication of the European Association of Urology (EAU). EU Focus will publish original articles, opinion piece editorials and topical reviews on a wide range of urological issues such as oncology, functional urology, reconstructive urology, laparoscopy, robotic surgery, endourology, female urology, andrology, paediatric urology and sexual medicine. The editorial team welcome basic and translational research articles in the field of urological diseases. Authors may be solicited by the Editor directly. All submitted manuscripts will be peer-reviewed by a panel of experts before being considered for publication.