cancerspЮжно-Российский онкологический журнал/ South Russian Journal of CancerSouth Russian Journal of Cancer2686-9039АНО "Перспективы онкологии"10.37748/2686-9039-2025-6-1-5qxdznfcancersp-319Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESАнализ дополнительных факторов прогноза у больных с метастазами рака почки в печеньAnalysis of additional prognostic factors in patients with renal cancer metastases to the liverhttps://orcid.org/0000-0002-4335-8446СеменовД. В.SemenovD. V.

Семенов Дмитрий Владимирович – д.м.н., доцент кафедры онкологии Медицинского факультета ФГБОУ ВО «Санкт-Петербургский государственный университет», г. Санкт-Петербург, Российская Федерация; врач отделения онкоурологии, СПб ГУЗ «Городской клинический онкологический диспансер», г. Санкт-Петербург, Российская Федерация

ORCID: https://orcid.org/0000-0002-4335-8446, SPIN: 2342-6530, AuthorID: 202214, ResearcherID: KQU-5717-2024, Scopus Author ID: 5859608180

Dmitry V. Semenov – Cand. Sci. (Med.), Associate Professor of the Department of Oncology, Faculty of Medicine St. Petersburg State University, Saint Petersburg, Russian Federation; doctor of the Oncourology department, City Clinical Oncological Dispensary, St. Petersburg, Russian Federation

ORCID: https://orcid.org/0000-0002-4335-8446, SPIN: 2342-6530, AuthorID: 202214, ResearcherID: KQU-5717-2024, Scopus Author ID: 58596081800

sema.69@mail.ruhttps://orcid.org/0000-0002-9368-5517ОрловаР. В.OrlovaR. V.

Орлова Рашида Вахидовна – д.м.н., профессор, заведующая кафедрой онкологии Медицинского факультета ФГБОУ ВО «Санкт-Петербургский государственный университет», г. Санкт-Петербург, Российская Федерация; главный специалист по клинической онкологии СПб ГУЗ «Городской клинический онкологический диспансер», г. Санкт-Петербург, Российская Федерация

ORCID: https://orcid.org/0000-0002-9368-5517, SPIN: 9932-6170, AuthorID: 401170

Rashida V. Orlova – Dr. Sci. (Med.), Professor, Head of the Department of Oncology, Faculty of Medicine St. Petersburg State University, Saint Petersburg, Russian Federation; Chief Specialist in Clinical Oncology, City Clinical Oncological Dispensary, St. Petersburg, Russian Federation

ORCID: https://orcid.org/0000-0002-9368-5517, SPIN: 9932-6170, AuthorID: 401170

orlova_rashida@mail.ruhttps://orcid.org/0000-0003-4109-6451ШирокоррадВ. И.ShirokoradV. I.

Широкорад Валерий Иванович – д.м.н., заведующий онкоурологическим отделением ГБУЗ «Московская городская онкологическая больница № 62 Департамента здравоохранения города Москвы», г. Москва, Российская Федерация

ORCID: https://orcid.org/0000-0003-4109-6451, AuthorID: 481900

Valery I. Shirokorad – Dr. Sci. (Med.), Head of the Oncourological Department Moscow City Oncological Hospital No. 62 of the Moscow City Health Department, Moscow, Russian Federation

ORCID: https://orcid.org/0000-0003-4109-6451, AuthorID: 481900

shirokorad@bk.ruhttps://orcid.org/0000-0003-4494-1489КострицкийС. В.KostritskyS. V.

Кострицкий Станислав Викторович – врач-онкоуролог, ГБУЗ «Московская городская онкологическая больница № 62 Департамента здравоохранения города Москвы», г. Москва, Российская Федерация

ORCID: https://orcid.org/0000-0003-4494-1489, SPIN: 1421-2469, AuthorID: 980451, ResearcherID: Y-6978-2018

Stanislav V. Kostritsky – MD, oncourologist, Moscow City Oncological Hospital No. 62 of the Moscow City Health Department, Moscow, Russian Federation

ORCID: https://orcid.org/0000-0003-4494-1489, SPIN: 1421-2469, AuthorID: 980451, ResearcherID: Y-6978-2018

Stas.medic@bk.ruФГБОУ ВО «Санкт-Петербургский государственный университет»; СПб ГУЗ «Городской клинический онкологический диспансер»РоссияSt. Petersburg State University; City Clinical Oncological DispensaryRussian FederationГБУЗ «Московская городская онкологическая больница № 62 Департамента здравоохранения города Москвы»РоссияMoscow City Oncological Hospital No. 62 of the Moscow City Health DepartmentRussian Federation202531012025614149Copyright © Семенов Д.В., Орлова Р.В., Широкоррад В.И., Кострицкий С.В., 20252025Семенов Д.В., Орлова Р.В., Широкоррад В.И., Кострицкий С.В.Semenov D.V., Orlova R.V., Shirokorad V.I., Kostritsky S.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.cancersp.com/jour/article/view/319Цель исследования

Цель исследования. Выявить дополнительные прогностические факторы у больных с метастазами рака почки в печень, влияющие на показатели выживаемости.

Пациенты и методы

Пациенты и методы. У пациентов с метастазами в печень почечноклеточного рака (ПКР) необходим поиск новых прогностических факторов, влияющих на показатели выживаемости. Проведен ретроспективный анализ данных 141 пациента с метастазами в печень ПКР, получавших лечение в ГБУЗ «Московская городская онкологическая больница № 62 Департамента здравоохранения города Москвы», г. Москвы и СПбГУЗ «Городской клинический онкологический диспансер», г. Санкт-Петербург с 2006 по 2022 гг., из которых преобладали мужчины (66,7 %), возраст 60–74 года, у 51,1 %, чаще выявлены низкодифференцированные опухоли (56,0 %) и наличие множественных метастазов (83,7 %). В исследовании изучены клинико-морфологические факторы прогноза, влияющие на показатели выживаемости у больных с метастазами в печень ПКР. Статистический анализ проводился с использованием пакетов программного обеспечения Statistica 10.0 (StatSoft, США) посредством построения кривых Каплана-Мейера и таблиц дожития, построение математической модели дожития.

Результаты

Результаты. 3- и 5-летняя общая выживаемость (ОВ) у больных с метастазами в печень ПКР (n = 141) составила 42,4 и 23,7 % соответственно, при этом медиана ОВ составила 22 месяца.

В однофакторном анализе у больных с метастазами рака почки в печени выявлено, что отрицательное влияние на показатели выживаемости оказывали статус по ECOG (p < 0,001), гистологический подтип (p = 0,01), степень дифференцировки опухоли по Fuhrman (p < 0,001), тип (p < 0,001) и количество метастазов (p = 0,024), метастазы в лимфатические узлы (p = 0,006), прогноз по IMDC (p < 0,001), проведение нефрэктомии (p < 0,001) и метастазэктомии (p = 0,0006).

При многофакторном анализе ECOG статус [HR = 10,09 (95 % ДИ = 1,31–77], гистологический подтип [HR = 3,45 (95 % ДИ = 1,77–6,71], метастазы в лимфатические узлы [HR = 1,93 (95 % ДИ = 1,21–3,07], уровень гемоглобина [HR = 2,44 (95 % ДИ = 1,39–4,29], а также проведение нефрэктомии [HR = 2,10 (95 % ДИ = 1,16–3,79] были дополнительными предикторами влияющими на показатели ОВ у пациентов с метастазами в печень ПКР.

Заключение

Заключение. В нашем исследовании ECOG статус, гистологический подтип, метастазы в лимфатические узлы, уровень гемоглобина и проведение нефрэктомии были дополнительными независимыми прогностическими факторами, влияющими на показатели ОВ у пациентов с метастазами в печень ПКР.

Purpose of the study

Purpose of the study. Was to identify additional prognostic factors in patients with renal cell cancer metastases to the liver influencing survival rates.

Patients and methods

Patients and methods. In patients with renal cell cancer (RCC) metastases to the liver, a search for new prognostic factors affecting survival rates is needed. The retrospective analysis of data of 141 patients with liver metastases of RCC treated at the Moscow City Oncological Hospital No. 62 in Moscow and the City Clinical Oncological Dispensary (St. Petersburg) from 2006 to 2022 was carried out. Men prevailed (66.7 %), age 60–74 years in 51.1 %, low-differentiated tumors (56,0 %) and multiple metastases (83.7 %) were detected more often. The study investigated clinical and morphological prognostic factors influencing survival rates in patients with liver metastases of RCC. Statistical analysis was performed using Statistica 10.0 software packages (StatSoft, USA) by constructing Kaplan-Meier curves and survival tables, building a mathematical model of survival.

Results

Results. The 3- and 5-year OS in patients with liver metastases of RCC (n = 141) was 42.4 % and 23.7 %, respectively, with a median OS of 22 months.

In a single-factor analysis in patients with renal cancer metastases to the liver, it was found that ECOG status (p < 0.001), histological subtype (p = 0.01) had a negative impact on survival rates, Fuhrman tumor differentiation (p < 0.001), type (p < 0.001) and number of metastases (p = 0.024), metastases to lymph nodes (p = 0.006), IMDC prognosis (p < 0.001), nephrectomy (p < 0.001) and metastasectomy (p = 0.0006).

In multivariate analysis, ECOG status [HR = 10.09 (95 % CI = 1.31–77], histological subtype [HR = 3,45 (95 % CI = 1.77–6.71], lymph node metastasis [HR = 1.93 (95 % CI = 1.21–3.07], hemoglobin level [HR = 2.44 (95 % CI=1.39–4.29], and undergoing nephrectomy [HR = 2.10 (95 % CI = 1.16–3.79] were additional predictors affecting OS rates in patients with liver metastases of RCC.

Conclusion

Conclusion. In our study, ECOG status, histological subtype, lymph node metastasis, hemoglobin level and nephrectomy were additional independent prognostic factors affecting AE rates in patients with RCC liver metastases. Further studies are needed to identify additional prognostic factors in patients with RCC liver metastases to improve the efficacy of personalized treatment.

почечноклеточный ракметастазы в печеньобщая выживаемостьпрогностические факторыrenal cell cancerliver metastasesoverall survival rateprognostic factorsReferencesBray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018 Nov;68(6):394–424. https://doi.org/10.3322/caac.21492Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortalityworldwide for 36 cancers in 185 countries. CA: Cancer J Clin (2018) 68:394–424. doi.org/10.3322/caac.21492.Capitanio U, Bensalah K, Bex A, Boorjian SA, Bray F, Coleman J, et al. Epidemiology of Renal Cell Carcinoma. Eur Urol. 2019 Jan;75(1):74–84. https://doi.org/10.1016/j.eururo.2018.08.036Capitanio U, Bensalah K, Bex A, Boorjian SA, Bray F, Coleman J, et al. Epidemiology of renal cell carcinoma. Eur Urol (2019) 75:74–84. doi: 10.1016/ j.eururo.2018.08.036.Pikoulis E, Margonis GA, Antoniou E. Surgical Management of Renal Cell Cancer Liver Metastases. Scand J Surg. 2016 Dec;105(4):263–268. https://doi.org/10.1177/1457496916630644Pikoulis E, Margonis G, Antoniou E. Surgical management of renal cell cancer liver metastases. Scandinavian J Surg (2016) 105:263–8. doi: 10.1177/1457496916630644.Capitanio U, Montorsi F. Renal cancer. Lancet. 2016 Feb 27;387(10021):894–906. https://doi.org/10.1016/S0140-6736(15)00046-XCapitanio U, Montorsi F. Renal cancer. Lancet (2016) 387:894–906. doi: 10.1016/S0140-6736(15)00046-X.Pecoraro A, Palumbo C, Knipper S, Mistretta FA, Rosiello G, Tian Z, et al. Synchronous Metastasis Rates in T1 Renal Cell Carcinoma: A Surveillance, Epidemiology, and End Results Database-based Study. Eur Urol Focus. 2021 Jul;7(4):818–826. https://doi.org/10.1016/j.euf.2020.02.011Pecoraro A, Palumbo C, Knipper S, Mistretta FA, Rosiello G, Tian Z, et al. Synchronous metastasis rates in T1 renal cell carcinoma: A surveillance, epidemiology, and end results database–based study. Eur Urol Focus (2021) 7:818–26. doi: 10.1016/j.euf.2020.02.011.Bianchi M, Sun M, Jeldres C, Shariat SF, Trinh QD, Briganti A, et al. Distribution of metastatic sites in renal cell carcinoma: a population-based analysis. Ann Oncol. 2012 Apr;23(4):973–980. https://doi.org/10.1093/annonc/mdr362(Bianchi M, Sun M, Jeldres C, Shariat SF, Trinh QD, Briganti A, et al. Distribution of metastatic sites in renal cell carcinoma: a population-based analysis. Ann Oncology: Off J Eur Soc Med Oncol (2012) 23:973–80. doi: 10.1093/annonc/mdr362.Alves A, Adam R, Majno P, Delvart V, Azoulay D, Castaing D, et al. Hepatic resection for metastatic renal tumors: is it worthwhile? Ann Surg Oncol. 2003 Jul;10(6):705–710. https://doi.org/10.1245/ASO.2003.07.024Alves A, Adam R, Majno P, Delvart V, Azoulay D, Castaing D, et al. Hepatic resection for metastatic renal tumors: is it worthwhile? Ann Surg Oncol (2003) 10:705–10. doi: 10.1245/ASO.2003.07.024.Hatzaras I, Gleisner AL, Pulitano C, Sandroussi C, Hirose K, Hyder O, et al. A multi-institution analysis of outcomes of liver-directed surgery for metastatic renal cell cancer. HPB (Oxford). 2012 Aug;14(8):532–538. https://doi.org/10.1111/j.1477-2574.2012.00495.xHatzaras I, Gleisner AL, Pulitano C, Sandroussi C, Hirose K, Hyder O, et al. A multi-institution analysis of outcomes of liver-directed surgery for metastatic renal cell cancer. HPB (2012) 14:532–8. doi:10.1111/j.1477-2574.2012.00495.x.Kim SH, Kim JK, Park EY, Joo J, Lee KH, Seo HK, et al. Liver metastasis and Heng risk are prognostic factors in patients with non-nephrectomized synchronous metastatic renal cell carcinoma treated with systemic therapy. PLoS One. 2019;14(2):e0211105. https://doi.org/10.1371/journal.pone.0211105Kim SH, Kim JK, Park EY, Joo J, Lee KH, Seo HK, et al. Liver metastasis and heng risk are prognostic factors in patients with non-nephrectomized synchronous metastatic renal cell carcinoma treated with systemic therapy. PloS One (2019) 14:e0211105. doi: 10.1371/journal.pone.0211105.Bowman IA, Pedrosa I, Kapur P, Brugarolas J. Renal Cell Carcinoma With Pulmonary Metastasis and Metachronous Non-Small Cell Lung Cancer. Clin Genitourin Cancer. 2017 Aug;15(4):e675–680. https://doi.org/10.1016/j.clgc.2017.01.026Bowman IA, Pedrosa I, Kapur P, Brugarolas J. Renal cell carcinoma with pulmonary metastasis and metachronous non-small cell lung cancer. Clin Genitourinary Cancer (2017) 15:e675–80. doi: 10.1016/j.clgc.2017.01.026).He Y, Luo Y, Huang L, Zhang D, Wang X, Ji J, et al. New frontiers against sorafenib resistance in renal cell carcinoma: From molecular mechanisms to predictive biomarkers. Pharmacol Res. 2021 Aug;170:105732. https://doi.org/10.1016/j.phrs.2021.105732He Y, Luo Y, Huang L, Zhang D, Wang X, Ji J, et al. New frontiers against sorafenib resistance in renal cell carcinoma: From molecular mechanisms to predictive biomarkers. Pharmacol Res (2021) 170:105732. doi: 10.1016/j.phrs.2021.105732.Rousseau B, Kempf E, Desamericq G, Boissier E, Chaubet-Houdu M, Joly C, et al. First-line antiangiogenics for metastatic renal cell carcinoma: A systematic review and network meta-analysis. Crit Rev Oncol Hematol. 2016 Nov;107:44–53. https://doi.org/10.1016/j.critrevonc.2016.08.012Rousseau B, Kempf E, Desamericq G, Boissier E, Chaubet-Houdu M, Joly C, et al. First-line antiangiogenics for metastatic renal cell carcinoma: a systematic review and network meta-analysis. Crit Rev Oncol/Hematol (2016) 107:44–53. doi: 10.1016/j.critrevonc.2016.08.012.Kim SH, Park WS, Park B, Pak S, Chung J. A Retrospective Analysis of the Impact of Metastasectomy on Prognostic Survival According to Metastatic Organs in Patients With Metastatic Renal Cell Carcinoma. Front Oncol. 2019;9:413. https://doi.org/10.3389/fonc.2019.00413Kim SH, Park WS, Park B, Pak S, Chung J. A retrospective analysis of the impact of metastasectomy on prognostic survival according to metastatic organs in patients with metastatic renal cell carcinoma. Front Oncol (2019) 9:413. doi:10.3389/fonc.2019.00413.Choueiri TK, Motzer RJ. Systemic Therapy for Metastatic Renal-Cell Carcinoma. N Engl J Med. 2017 Jan 26;376(4):354–366. https://doi.org/10.1056/NEJMra1601333Choueiri TK, Motzer RJ. Systemic therapy for metastatic renal-cell carcinoma. New Engl J Med (2017) 376:354–66. doi: 10.1056/NEJMra1601333.Motzer RJ, Tannir NM, McDermott DF, Arén Frontera O, Melichar B, Choueiri TK, et al. Nivolumab plus Ipilimumab versus Sunitinib in Advanced Renal-Cell Carcinoma. N Engl J Med. 2018 Apr 5;378(14):1277–1290. https://doi.org/10.1056/NEJMoa1712126Motzer RJ, Tannir NM, McDermott DF, Arén Frontera O, Melichar B, Choueiri TK, et al. Nivolumab plus ipilimumab versus sunitinib in advanced renalcell carcinoma. New Engl J Med (2018) 378:1277–90. doi: 10.1056/NEJMoa1712126.Hahn AW, Klaassen Z, Agarwal N, Haaland B, Esther J, Ye XY, et al. First-line Treatment of Metastatic Renal Cell Carcinoma: A Systematic Review and Network Meta-analysis. Eur Urol Oncol. 2019 Nov;2(6):708–715. https://doi.org/10.1016/j.euo.2019.09.002Hahn AW, Klaassen Z, Agarwal N, Haaland B, Esther J, Ye XY, et al. Firstline treatment of metastatic renal cell carcinoma: A systematic review and network meta-analysis. Eur Urol Oncol (2019) 2:708–15. doi: 10.1016/j.euo.2019.09.002.Bruns F, Christiansen H. Is there always a need for invasive treatment of limited liver metastases in renal cell cancer or other solid tumors? World J Urol. 2015 Mar;33(3):443–444. https://doi.org/10.1007/s00345-014-1331-4Bruns F, Christiansen H. Is there always a need for invasive treatment of limited liver metastases in renal cell cancer or other solid tumors? World J Urol (2015) 33:443–4. doi: 10.1007/s00345-014-1331-4).Verbiest A, Renders I, Caruso S, Couchy G, Job S, Laenen A, et al. Clear-cell Renal Cell Carcinoma: Molecular Characterization of IMDC Risk Groups and Sarcomatoid Tumors. Clin Genitourin Cancer. 2019 Oct;17(5):e981–94. https://doi.org/10.1016/j.clgc.2019.05.009Verbiest A, Renders I, Caruso S, Couchy G, Job S, Laenen A, et al. Clear-cell renal cell carcinoma: molecular characterization of IMDC risk groups and sarcomatoid tumors. Clin Genitourinary Cancer (2019) 17:e981–94. doi: 10.1016/ j.clgc.2019.05.009.Albiges L, Powles T, Staehler M, Bensalah K, Giles RH, Hora M, et al. Updated European Association of Urology Guidelines on Renal Cell Carcinoma: Immune Checkpoint Inhibition Is the New Backbone in First-line Treatment of Metastatic Clear-cell Renal Cell Carcinoma. Eur Urol. 2019 Aug;76(2):151–156. https://doi.org/10.1016/j.eururo.2019.05.022Albiges L, Powles T, Staehler M, Bensalah K, Giles RH, Hora M, et al. Updated European association of urology guidelines on renal cell carcinoma: immune checkpoint inhibition is the new backbone in first-line treatment of metastatic clear-cell renal cell carcinoma. Eur Urol (2019) 76:151–6. doi: 10.1016/j.eururo.2019.05.022.

The authors declare that there are no conflicts of interest present.