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Vol. 45. Issue 7.
Pages 498-506 (September 2021)
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Vol. 45. Issue 7.
Pages 498-506 (September 2021)
Original article
DOI: 10.1016/j.acuroe.2021.06.004
Population-based evaluation of the risk factors and prognosis among renal cell carcinoma patients with initially diagnosed lung metastases
Estudio poblacional de los factores de riesgo y factores pronósticos en pacientes con diagnóstico inicial de carcinoma de células renales con metástasis pulmonares
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Z. Zhanga,
Corresponding author
zhenzhang1987@163.com

Corresponding author.
, C. Liangb, B. Houa, L. Zhoua
a Department of Urology, The Fourth Affiliated Hospital of Anhui Medical University, Hefei, China
b Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
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Tables (3)
Table 1. Characteristics of participants, stratified by presence of lung metastases at time of diagnosis.
Table 2. Summary of risk factors for developing lung metastases at diagnosis based on univariable and multivariable logistic regression analyses.
Table 3. Multivariable cox regression model for predicting prognosis in RCC patients with lung metastases at diagnosis.
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Abstract
Objectives

To evaluate risk factors and prognosis of lung metastases in patients with renal cell carcinoma (RCC) based on the Surveillance, Epidemiology, and End Results (SEER) database.

Methods

56,617 patients with RCC were selected from the SEER database. Based on univariate and multivariate logistic regression, the risk factors for developing lung metastases were derived. 2906 patients were initially diagnosed with lung metastases, and then were used to research the prognostic factors. Multivariable Cox regression analyses were performed for the prediction of cancer-specific mortality.

Results

In total, 2906 RCC patients were initially diagnosed with lung metastases. The prevalence of lung metastases in RCC was approximately 5% with poor survival. Aging, male, other race (American Indian/AK native, Asian Pacific islander) uninsured status, bilateral tumor, collecting duct, higher T stage, local lymph node metastases, higher tumor grade, and evidence of other distant metastases were significantly associated with developing lung metastases at diagnosis. Age >70 years-old, black, female, bilateral tumor, T4 stage, higher tumor grade, local lymph node metastases, collecting duct, and evidence of bone, liver, or brain metastases were related to higher risk of mortality. Blacks and female have lower odds of developing lung metastases at the time of diagnosis both in crude and adjusted logistic regression. Meanwhile, blacks and female showed higher risk of mortality compared with whites and male in Cox regression analyses.

Conclusion

Several factors related to the development and prognosis of lung metastases were revealed, especially black people and female gender have lower risk of developing lung metastatic RCC at initial diagnosis but have higher risk of mortality. These may provide preventive guidelines for the screening and treatment of lung metastases in patients with renal cell carcinoma.

Keywords:
Renal cell carcinoma
Lung metastases
Risk factor
Prognosis
Resumen
Objetivos

Evaluar los factores de riesgo y los factores pronósticos de las metástasis pulmonares en pacientes con carcinoma de células renales (CCR) de la base de datos del Surveillance, Epidemiology and End Results (SEER).

Métodos

Se seleccionaron 56.617 pacientes con CCR de la base de datos del SEER. De acuerdo con la regresión logística univariante y multivariante, se derivaron los factores de riesgo para desarrollar metástasis pulmonares. Se diagnosticaron, inicialmente, 2.906 casos con metástasis pulmonares y, posteriormente, se evaluaron los factores pronósticos. Se realizaron modelos multivariantes de regresión de Cox para predecir la mortalidad específica por cáncer.

Resultados

En total, 2.906 pacientes padecían CCR y metástasis pulmonares al diagnóstico. La prevalencia de estas últimas en el CCR era de aproximadamente el 5% con una tasa de supervivencia baja. La edad avanzada, el sexo masculino, pertenecer a alguna otra raza (nativo americano/nativo de Alaska, isleño del Pacífico/asiático), el estatus de no asegurado, el tumor bilateral, el carcinoma del túbulo colector, el estadio tumoral (T) alto, las metástasis en los ganglios linfáticos locales, el grado tumoral alto y la evidencia de otras metástasis a distancia se asociaron significativamente con la metástasis pulmonar al diagnóstico. Factores como la edad >70 años, la raza negra, el sexo femenino, el tumor bilateral, la etapa T4, el grado tumoral alto, las metástasis en los ganglios linfáticos locales, el carcinoma del túbulo colector y la evidencia de metástasis en los huesos, el hígado o el cerebro estaban relacionados con un mayor riesgo de mortalidad. Los pacientes de raza negra y de sexo femenino tienen menos probabilidades de desarrollar metástasis pulmonar en el momento del diagnóstico, tanto en la regresión logística cruda, como en la ajustada. De igual manera, estas mismas características mostraron estar asociadas con un mayor riesgo de mortalidad en comparación con las personas de raza blanca y de sexo masculino en los análisis de regresión de Cox.

Conclusión

Se revelaron varios factores relacionados con el desarrollo y el pronóstico de las metástasis pulmonares; especialmente las personas de raza negra y de sexo femenino tienen una probabilidad menor de desarrollar un CCR con metástasis pulmonar en el momento del diagnóstico inicial, pero tienen un mayor riesgo de mortalidad. Estos datos pueden proporcionar directrices preventivas para la detección y el tratamiento de las metástasis pulmonares en pacientes con carcinoma de células renales.

Palabras clave:
Carcinoma de células renales
Metástasis pulmonares
Factor de riesgo
Pronóstico

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