As the most common metastasis site in renal cell carcinoma (RCC) patients, lung and bronchus metastasis (LBM) represents a late stage and a poor prognosis. The purpose of our study is to determine the impact of surgical intervention on prognosis of RCC patients with LBM by means of analysis the data from the Surveillance, Epidemiology and End Results (SEER) database.
The population data of RCC patients with LBM was extracted from the SEER database [1973-2015]. For each patient, age, gender, race, region, tumor histology, cause of death to site record, tumor grade, surgical intervention, and overall survival time were extracted from SEER database. Baseline characteristics were compared using the χ2 test for the categorical variables. The survival analysis was estimated using the Kaplan-Meier (K-M) method and univariate comparison were performed using the log-rank test and unadjusted Cox proportional hazards regression models. Multivariate Cox proportional hazards regression survival models were adjusted. A second multivariate Cox proportional hazards regression survival model was created using the dataset after propensity score-matching approach (PSM).
A total of 1,190 RCC patients with LBM were included, of whom 1,087 patients underwent surgery and 103 patients unperformed surgery. The median survival time was 56 months (95% CI, 54 to 59) for the surgery group, and 6 months (95% CI, 5 to 7) for non-surgery group. LBM patients underwent surgery had significantly longer survival time (log-rank test, P<0.001). In univariate analysis, the survival of RCC patients was significantly associated with surgery (P<0.001), grade II (P=0.014), grade III (P=0.001) and grade IV (P<0.001). Moreover, multivariate analysis indicated that surgery (P<0.001), grade II (P=0.018), grade III (P<0.001) and grade IV (P<0.001) were independent prognostic indexes for overall survival. Besides, in the subgroup of 1 years survival after diagnosis, longer survival times were seen in the surgery arms rather than non-surgery arms (P<0.001). In addition, longer survival times were observed in surgery arms in the subgroups of grade I, II, III and IV (all P<0.001).
RCC patients with LBM who have surgical intervention might obtain a significantly longer survival time than non-surgical options. In consequence, surgery should be the preferred choice for eligible patients.
Annals of translational medicine. 2019 Jul [Epub]
Shaofeng Lin, Yuxiao Zheng, Zongshi Qin, Xin Hu, Feng Qi, Rong Yin, Lin Xu, Xiao Li
Department of Thoracic Surgery, Nanjing Medical University Affiliated Cancer Hospital & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Jiangsu Key Laboratory of Molecular and Translational Cancer Research, Nanjing 210009, China., Department of Urologic Surgery, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & Affiliated Cancer Hospital of Nanjing Medical University, Nanjing 210009, China., School of Chinese Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong 999077, China., First Clinical Medical College of Nanjing Medical University, Nanjing 210029, China., Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.