ABSTRACT
<p><b>BACKGROUND</b>The metastatic renal cell carcinoma (mRCC) patients treated with upfront cytoreductive nephrectomy combined with α-interferon yields additional overall survival (OS) benefits. It is unclear whether mRCC patients treated with vascular endothelial growth factor receptor-tyrosine kinase inhibitor (VEGFR-TKI) will benefit from such cytoreductive nephrectomy either. The aim of the study was to identify variables for selection of patients who would benefit from upfront cytoreductive nephrectomy for mRCC treated with VEGFR-TKI.</p><p><b>METHODS</b>Clinical data on 74 patients enrolled in 5 clinical trials conducted in Cancer Hospital (Institute), Chinese Academy of Medical Sciences from January 2006 to January 2014 were reviewed retrospectively. The survival analysis was performed by the Kaplan-Meier method. Comparisons between patient groups were performed by Chi-square test. A Cox regression model was adopted for analysis of multiple factors affecting survival, with a significance level of α = 0.05.</p><p><b>RESULTS</b>Fifty-one patients underwent cytoreductive nephrectomy followed by targeted therapy (cytoreductive nephrectomy group) and 23 patients were treated with targeted therapy alone (noncytoreductive nephrectomy group). The median OS was 32.2 months and 23.0 months in cytoreductive nephrectomy and noncytoreductive nephrectomy groups, respectively (P = 0.041). Age ≤45 years (P = 0.002), a low or high body mass index (BMI <19 or >30 kg/m2) (P = 0.008), a serum lactate dehydrogenase (LDH) concentration >1.5 × upper limit of normal (P = 0.025), a serum calcium concentration >10 mg/ml (P = 0.034), and 3 or more metastatic sites (P = 0.023) were independent preoperative risk factors for survival. The patients only with 0-2 risk factors benefited from upfront cytoreductive nephrectomy in terms of OS when compared with the patients treated with targeted therapy alone (40.0 months vs. 23.2 months, P = 0.042), while those with more than 2 risk factors did not.</p><p><b>CONCLUSIONS</b>Five risk factors (age, BMI, LDH, serum calcium, and number of metastatic sites) seemed to be helpful for selecting patients who would benefit from undergoing upfront cytoreductive nephrectomy.</p>
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Carcinoma, Renal Cell , Mortality , General Surgery , Cytoreduction Surgical Procedures , Kidney Neoplasms , Mortality , General Surgery , Nephrectomy , Proportional Hazards ModelsABSTRACT
<p><b>OBJECTIVE</b>To explore the prognostic factors in patients with gastric cancer (GC) or adenocarcinoma of the esophagogastric junction (AEG) combined with malignant pleural and/or abdominal effusion.</p><p><b>METHODS</b>Clinicopathological data of 111 GC or AEG patients with malignant pleural and/or abdominal effusion treated in our hospital from January 2001 to December 2010 were retrospectively analyzed.</p><p><b>RESULTS</b>The median survival time for the whole group of 111 patients was 6 months. Effusion disappeared in 12 patients, was reduced in 36 cases, with no changes in 15 cases, and increased in 48 patients. The effusion control rate was 56.8%. Effusion was better controlled in female patients, with simple abdominal ascites, Karnovsky performance scores ≥ 80, with no liver metastases, effusion at initial diagnosis, and effective response to systemic chemotherapy.Univariate analysis showed that patients of female sex, Karnovsky performance scores ≥ 80, effusion present at initial diagnosis, simple abdominal ascites, minimal volume of effusion, absence of liver metastasis, control of effusion, initial treatment with effusions and effective response to systemic chemotherapy, normal hemoglobin, albumin, direct and indirect bilirubin levels showed better prognosis (all P < 0.05). Multivariate analysis showed that liver metastases, control of effusions were independent prognostic factors in patients with gastric cancer and adenocarcinoma of the esophagogastric junction (all P < 0.05).</p><p><b>CONCLUSIONS</b>Female patients, simple abdominal ascites, KPS scores ≥ 80, ascites at initial diagnosis, no liver metastases and effective systemic chemotherapy seem to have a better control of the malignant effusion. Patients with no liver metastases and effective control of effusion have a longer survival time.</p>