Analysis Of Factors Influencing The Prognosis Of Sunitinib In The Treatment Of Metastatic Renal Cell Carcinoma

OBJECTIVE: To analyze the prognostic factors influencing metastatic renal cell carcinoma based on sunitinib as a first-line targeted drug.METHODS: The clinical data of 64 patients with metastatic renal cell carcinoma treated with oral sunitinib in our department of urology from March,2012 to July,2018 were selected.The clinical diagnosis and follow-up information of all patients were collected and analyzed.It includes follow-up information such as general information of patients,diagnosis and treatment,pathological types,previous review of imaging data,and survival status.To study the effect of sunitinib in patients with advanced renal cell carcinoma,the Kaplan-Meier method was used to analyze the variables by univariate analysis and the survival curve was made.Variables with P < 0.05 were included in the Cox proportional hazard regression model for further multivariate analysis to determine independent risk factors.RESULTS: A total of 47 deaths occurred and 17 survived.There were 0 cases(0%)with complete remission(CR),8 cases(12.5%)with partial remission(PR),43 cases(67.2%)with stable disease(SD),and 13 cases(20.3%)with disease progression(PD).The objective response rate(ORR)was 12.5%;the disease control rate(DCR)was 79.7%.The median PFS was 10.0 months(95% CI: 8.26 to 11.74 months)and the median OS was 18.0 months(95% CI: 12.42 to 23.58 months).Univariate analysis showed that ECOG score,bone metastasis,lymph node metastasis,number of metastases,and surgical procedure were independent influencing factors of PFS(P<0.05);Age,ECOG score,surgical procedure,and mode of administration were independent influencing factors of OS(P<0.05).The results of stepwise Cox multivariate analysis showed ECOG score(HR value: 1.480,95% CI: 1.131~1.398),bone metastasis(HR value: 2.346,95% CI: 1.195~4.607),and lymph node metastasis(HR value: 2.006,95%CI: 1.150~3.502)were independent factors affecting PFS(P<0.05).The full-scale Cox multivariate analysis showed ECOG score(HR Value: 2.070,95% CI: 1.511~2.835)is an independent factor affecting OS(P<0.05).CONCLUSION:(1).ECOG score,bone metastasis,and lymph node metastasis are independent risk factors for the effect of sunitinib in the treatment of metastatic renal cell carcinoma.The median PFS of patients with single lymph node metastasis is significantly longer than that of patients with multiple lymph node metastases.Median PFS is better than untreated patients;(2).ECOG score is an independent risk factor for the effect of sunitinib in the treatment of metastatic renal cell carcinoma.The effective response of young patients to the median OS of sunitinib is significantly better than that of elderly patients.The median OS of patients treated with sunitinib after surgical resection was significantly better than that of direct targeted drug therapy.