Background: The aim was to investigate whether patient-related or clinical risk factors present at the diagnosis of advanced stage renal cell carcinoma (RCC) had an impact on the overall mortality, cancer-specific mortality, and recurrence risk in a national cohort. Methods: Patients registered with stage III and IV RCC in the Danish Renal Cancer Database (DaRenCa) in 2014–2016 were included in the study and followed up until recurrence or death. We conducted a Cox Proportional Hazard Model to examine the association between several variables and the development of RCC. These variables included BMI, hypertension, smoking status, symptoms at diagnosis, performance status, multidisciplinary team (MDT) discussion, surgical margin, and primary metastasis. Separate analyses were performed for cc-RCC and non-ccRCC patients. Results: In our cohort of 929 patients, 424 individuals died from RCC during the follow-up period, with a median follow-up time of 4.1 (95% CI: 0.8–5.0) years for ccRCC and 2.0 (95% CI: 0.1–5.0) years for non-ccRCC. A multivariate analysis demonstrated that a positive surgical margin (HR 1.53 and 1.43), synchronous metastasis (HR 2.06 and 3.23), and poor performance status (HR 4.73 and 5.27) were significantly associated with a decreased 5-year overall and cancer-specific survival, respectively. Furthermore, a positive surgical margin was associated with a higher risk of recurrence in ccRCC. MDT discussion was found to reduce mortality risk in non-ccRCC. Conclusion: Clinical- and disease-related variables have a greater impact on RCC mortality and recurrence than the selected lifestyle-related factors. The inclusion of MDT discussion in the diagnosis and management of advanced RCC should be further evaluated for its potential to improve patient outcomes.
背景：本研究旨在探讨晚期肾细胞癌（RCC）诊断时存在的患者相关或临床危险因素是否对全国性队列的总死亡率、癌症特异性死亡率及复发风险产生影响。方法：研究纳入2014年至2016年在丹麦肾癌数据库（DaRenCa）中登记的III期和IV期RCC患者，并随访至复发或死亡。采用Cox比例风险模型分析体重指数、高血压、吸烟状况、诊断时症状、体能状态、多学科团队讨论、手术切缘状态及原发性转移等多个变量与RCC进展的关联性，并对透明细胞肾细胞癌与非透明细胞肾细胞癌患者分别进行分析。结果：在929例患者队列中，随访期间共有424例患者死于RCC。透明细胞肾细胞癌患者中位随访时间为4.1年（95% CI：0.8-5.0），非透明细胞肾细胞癌患者为2.0年（95% CI：0.1-5.0）。多变量分析显示，手术切缘阳性（风险比分别为1.53和1.43）、同期转移（风险比分别为2.06和3.23）及体能状态不佳（风险比分别为4.73和5.27）均与5年总生存率和癌症特异性生存率下降显著相关。此外，手术切缘阳性与透明细胞肾细胞癌的更高复发风险相关。研究发现多学科团队讨论可降低非透明细胞肾细胞癌患者的死亡风险。结论：与所选生活方式因素相比，临床及疾病相关变量对肾细胞癌死亡率和复发风险的影响更为显著。应进一步评估在晚期肾细胞癌诊疗中引入多学科团队讨论对改善患者预后的潜在价值。
Lifestyle and Clinical Factors in a Nationwide Stage III and IV Renal Cell Carcinoma Study
肿瘤(癌症)患者之家