Prediction of early progression of metastatic renal cell carcinoma treated with first-line tyrosine kinase inhibitor

Autor: Jun Teishima, Daiki Murata, Shogo Inoue, Tetsutaro Hayashi, Koji Mita, Yasuhisa Hasegawa, Masao Kato, Mitsuru Kajiwara, Masanobu Shigeta, Satoshi Maruyama, Hiroyuki Moriyama, Seiji Fujiwara, Akio Matsubara
Jazyk: angličtina
Rok vydání: 2021
Předmět:
Zdroj: Current Urology, Vol 15, Iss 4, Pp 187-192 (2021)
Druh dokumentu: article
ISSN: 1661-7649
1661-7657
00000000
DOI: 10.1097/CU9.0000000000000042
Popis: Abstract. Background:. There are various alternative first-line therapeutic options besides tyrosine kinase inhibitors (TKIs) for metastatic renal cell carcinoma (mRCC). To inform therapeutic decision-making for such patients, this study aimed to identify predictive factors for resistance to TKI. Materials and methods:. A total of 239 cases of mRCC patients who received first-line TKI therapy were retrospectively studied. Patients with a radiologic diagnosis of progressive disease within 3 months after initiating therapy were classified as primary refractory cases; the others were classified as non-primary refractory cases. The association between primary refractory cases and age, gender, pathology findings, serum c-reactive protein (CRP) level, metastatic organ status, and 6 parameters defined by the International Metastatic Renal Cell Carcinoma Database Consortium were analyzed. Results:. Of 239 cases, 32 (13.3%) received a radiologic diagnosis of progressive disease within 3 months after initiating therapy. The rates of sarcomatoid differentiation, hypercalcemia, a serum CRP level of 0.3 mg/dL or higher, presence of liver metastasis, anemia, and time from diagnosis to treatment interval of less than a year were significantly higher in the primary refractory group. Multivariate analysis showed that sarcomatoid differentiation, hypercalcemia, a serum CRP level of 0.3 mg/dL or higher, and liver metastasis were independently associated with primary refractory disease. A risk-stratified model based upon the number of patients with these factors indicated rates of primary refractory disease of 4.0%, 10.1%, and 45.0% for patients with 0, 1, and 2 or more factors, respectively. Conclusions:. Sarcomatoid differentiation, hypercalcemia, an elevated serum CRP level, and presence of liver metastasis were associated with primary refractory disease in mRCC patients receiving first-line TKI therapy. These results provide clinicians with useful information when selecting a first-line therapeutic option for mRCC patients.
Databáze: Directory of Open Access Journals
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