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Changes in therapy and survival of metastatic renal cell carcinoma in Estonia
BMC Cancer ( IF 3.8 ) Pub Date : 2020-03-12 , DOI: 10.1186/s12885-020-6685-y
Hannes Jürgens , Kristiina Ojamaa , Helis Pokker , Kaire Innos , Peeter Padrik

Before the era of targeted therapies, cytokines were the main therapy for metastatic renal cell carcinoma (mRCC). Our aim was to analyze the changes in treatments and overall survival (OS) of all mRCC patients in Estonia in relation to the introduction of new medications. All patients with mRCC who started medical therapy in Estonia during the years 2004–2012 were identified using the database of the Estonian Health Insurance Fund. Tumor and treatment data were gathered from medical records. Vital status data were obtained from the Estonian Population Registry. The only available therapy before 2008 was interferon alpha-2A (INFa2A), targeted agents added from 2008. For survival analysis, patients were divided into 2 groups: INFa therapy only (group 1) and INFa followed by targeted agents or targeted agents therapy only (group 2). Out of 416 identified patients, 380 were eligible for analysis. The most common 1st-line treatments were INFa (55%), sunitinib (32%) and INFa+bevacizumab (13%). 28% of patients received 2nd-line therapies and 15% 3rd-line treatments. Median survival of all patients was 13.7 months [95% confidence interval (CI) 11.3–16.2]; 7.6 months (CI 6.4–8.6) for group 1 and 19.8 months (CI 15.6–22.9) for group 2. In multivariate analysis, group 1 had nearly four times higher risk of dying than group 2 [hazard ration (HR) 3.88, 95% CI 2.64–5.72]. The implementation of targeted therapies significantly changed the outcomes of mRCC in Estonia: it prolonged median survival, reduced the risk of death and also enlarged the proportion of patients who received medical therapy.

中文翻译:

爱沙尼亚转移性肾细胞癌的治疗和生存变化

在靶向疗法时代之前,细胞因子是转移性肾细胞癌(mRCC)的主要疗法。我们的目的是分析爱沙尼亚所有mRCC患者与新药的引入相关的治疗方法和总体生存率(OS)的变化。使用爱沙尼亚健康保险基金的数据库确定了2004-2012年在爱沙尼亚开始接受药物治疗的所有mRCC患者。从医疗记录中收集肿瘤和治疗数据。生命状态数据从爱沙尼亚人口登记处获得。2008年之前唯一可用的疗法是干扰素α-2A(INFa2A),从2008年开始加入靶向药物。为了进行生存分析,将患者分为两组:仅INFa治疗(第1组)和INFa,然后是靶向药物或仅靶向药物治疗(第2组)。在确定的416名患者中,有380名符合分析条件。一线治疗最常见的是INFa(55%),舒尼替尼(32%)和INFa +贝伐单抗(13%)。28%的患者接受了二线治疗,而15%的患者接受了三线治疗。所有患者的中位生存期为13.7个月[95%置信区间(CI)11.3-16.2];第1组为7.6个月(CI 6.4–8.6),第2组为19.8个月(CI 15.6–22.9)。在多变量分析中,第1组的死亡风险比第2组高近四倍[危险度(HR)3.88,95 %CI 2.64–5.72]。在爱沙尼亚,靶向治疗的实施显着改变了mRCC的结局:它延长了中位生存期,降低了死亡风险,并扩大了接受药物治疗的患者比例。一线治疗最常见的是INFa(55%),舒尼替尼(32%)和INFa +贝伐单抗(13%)。28%的患者接受了二线治疗,而15%的患者接受了三线治疗。所有患者的中位生存期为13.7个月[95%置信区间(CI)11.3-16.2];第1组为7.6个月(CI 6.4–8.6),第2组为19.8个月(CI 15.6–22.9)。在多变量分析中,第1组的死亡风险比第2组高近四倍[危险度(HR)3.88,95 %CI 2.64–5.72]。在爱沙尼亚,靶向治疗的实施显着改变了mRCC的结局:它延长了中位生存期,降低了死亡风险,并扩大了接受药物治疗的患者比例。一线治疗最常见的是INFa(55%),舒尼替尼(32%)和INFa +贝伐单抗(13%)。28%的患者接受了二线治疗,而15%的患者接受了三线治疗。所有患者的中位生存期为13.7个月[95%置信区间(CI)11.3-16.2];第1组为7.6个月(CI 6.4–8.6),第2组为19.8个月(CI 15.6–22.9)。在多变量分析中,第1组的死亡风险比第2组高近四倍[危险度(HR)3.88,95 %CI 2.64–5.72]。在爱沙尼亚,靶向治疗的实施显着改变了mRCC的结局:它延长了中位生存期,降低了死亡风险,并扩大了接受药物治疗的患者比例。所有患者的中位生存期为13.7个月[95%置信区间(CI)11.3-16.2];第1组为7.6个月(CI 6.4–8.6),第2组为19.8个月(CI 15.6–22.9)。在多变量分析中,第1组的死亡风险比第2组高近四倍[危险度(HR)3.88,95 %CI 2.64–5.72]。在爱沙尼亚,靶向治疗的实施显着改变了mRCC的结局:它延长了中位生存期,降低了死亡风险,并扩大了接受药物治疗的患者比例。所有患者的中位生存期为13.7个月[95%置信区间(CI)11.3-16.2];第1组为7.6个月(CI 6.4–8.6),第2组为19.8个月(CI 15.6–22.9)。在多变量分析中,第1组的死亡风险比第2组高近四倍[危险度(HR)3.88,95 %CI 2.64–5.72]。在爱沙尼亚,靶向治疗的实施显着改变了mRCC的结局:它延长了中位生存期,降低了死亡风险,并扩大了接受药物治疗的患者比例。
更新日期:2020-03-12
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