Böbrek Hücreli Karsinomlu Hastaların Demografik Özellikleri ve Tedavi Sonuçları: Tek Merkez Deneyimi

Öz

Amaç: Çalışmanın amacı, böbrek hücreli karsinomlu (BHK) hastaların demografik özellikleri ve tedavi sonuçlarını değerlendirmektir.

Materyal-Metot:  2005- 2014 yılları arasında Ankara Atatürk Eğitim ve Araştırma Hastanesi’nde BHK tanısı ile takip edilen 100 hastaya ait veriler geriye dönük olarak incelendi. Sağkalım analizi için Kaplan–Meier yöntemi kullanıldı.

Bulgular: Hastaların ortanca yaşı 62 (25.0 -89.0) olup, %40’ı 65 yaş üstündeydi.  Erkek / kadın  hasta  oranı  2.1 olarak saptandı. Hastaların %64’üne radikal nefrektomi, %7’sine parsiyel nefrektomi uygulanmıştı. Histopatolojik olarak berrak hücreli tip  %84 oranındaydı. Çoğunluğunu evre IV hastalar oluşturmaktaydı (%55.0) ve en sık metastaz bölgesi akciğerdi (%34).  Hastaların 62’si metastaz sonrası ilk basamakta interferon (IFN) tedavisi, IFN sonrası tirozin kinaz inhibitörünü (TKI) ise 49 hasta almıştı. Tüm hastaların ortanca takip süresi 24 ay ve ortanca genel sağkalım (GS) 36 ay idi. Sunitinib kullanan hastalarda ise ortanca GS 30.0 ay ve ortanca progresyonsuz sağkalım (PS) 15 ay bulundu. Sunitinib tedavisi sırasında hastaların %53.8’inda doz azaltımı yapıldı ve %36.6’sında tedaviye ara verildi. Grade 3-4 toksisiteler içinde en sık halsizlik (%34.9) ve anemi (%27.9) saptandı. Sunitinib kullanan hastalarda Memorial Sloan Kettering Cancer Center (MSKCC) kriterlerine göre iyi, orta, kötü riskli hastalarda ortanca PS’ler ise sırasıyla 45, 15 ve 6 ay idi (p=0.05). Çok değişkenli analizde  yaşın 65’in üstünde olması (p=0.04), gradın 3-4 olması (p=0.05) ve  MSKCC kriterlerine (sunitinib için) göre kötü riskli olmanın (p=0.04) GS’ı kısalttığı saptandı.   

Sonuç: Çalışmamızda hastalarımızın çoğu erkek, 65 yaşından genç ve tanıda ileri evredeydi. Kliniğimizde takip ettiğimiz BHK’li nefrektomi geçiren hastalarda ve metastatik aşamada bir TKI olan sunitinib kullanan hastalarda sağkalım sürelerinde belirgin iyileşme olduğu gözlendi. 

Anahtar Kelimeler

• böbrek hücreli kanser,tirozin kinaz inhibitör,sunitinib

Demographic Characteristics and Treatment Outcomes of Patients with Renal Cell Cancer: Single Center Experience

Abstract

Objectives: The aim of the study was to evaluate demographic characteristics and treatment outcomes of patients with renal cell cancer. 

Materials and Methods: Data of 100 patients diagnosed with RCC at Atatürk Research and Education Hospital between the years 2005-2014 are analyzed retrospectively. Kaplan-Meier test were performed for survival analysis. 

Results: Median age of patients was 62 (25-89) and 40% of the population was over 65 years old. Sex ration (male/female)  was 2/1. Radical nephrectomy was perfomed 64 % of patients also partial nephrectomy rate was 7%.  Histopathologically, clear cell varient’s rate was 84 %. Most of the patients were stage 4 (55%)  and the most common metastatic site was lung (34%). After the development of metastases, first line interferone (IFN) treatment was administered to 62 of patients and 49 of these took tirosine kinase inhibitor after IFN treatment. For all patients, median follow-up time was 24 months and median overall survival (OS) was 36 months. We determined that OS was 30 months and progression free survival (PFS) was 15 months among patients had recieved sunitinib. During sunitinib treatment, dose reduction was performed in 53.8% of the patients and treatment was interrupted in 36.6% of the patients. Fatigue (34.9%) and anemia (27.9%) were the most common grade 3-4 toxicities. In patients who used sunitinib, median PFS in the good, intermediate and poor risk patients according to Memorial Sloan Kettering Cancer Center (MSKCC) criteria respectively were 45, 15 and 6 months (p=0.05). In multivariate analysis, we found that age over 65 years  (p=0.04),  grade 3-4 tumors (p=0.05) and the poor risk according to MSKCC criteria (p=0,04) are associated with decreased overall survival.

Conclusion: The majority of our patients were male, younger than 65 years and had advanced disease at diagnosis. The significantly improvement in survival has been observed between the nephrectomized and metastatic RCC patients who used sunitinib at our clinic.

Keywords

• Renal cell cancer,tyrosine kinase inhibitor,sunitinib

Kaynakça

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