合并第二原发雌激素相关肿瘤的肾细胞癌的临床特征：倾向评分匹配分析

背景与目的：随着肿瘤诊疗技术的进步，肿瘤患者的生存时间不断延长，第二原发肿瘤在临床上的报道也越来越多。探讨合并第二原发雌激素相关肿瘤的肾细胞癌（renal cell carcinoma，RCC）临床和病理学特征。方法：回顾性纳入2008年1月—2019年1月复旦大学附属肿瘤医院诊治的女性RCC患者520例，其中合并第二原发雌激素相关肿瘤39例，单一RCC 481例。本研究应用倾向评分匹配（propensity score matching，PSM）法对两类患者临床资料按1∶5进行匹配，比较两组患者临床病理学特点［年龄、体质量指数（body mass index，BMI）、肿瘤家族史、TNM分期、美国癌症联合会（American Joint Committee on Cancer，AJCC）临床分期等］。通过Kaplan-Meier法统计合并第二原发雌激素相关肿瘤RCC患者和单一RCC患者的预后情况。结果：经过倾向评分匹配后，合并第二原发雌激素相关肿瘤38例，单一RCC 185例。两组患者肿瘤家族史倾向评分匹配前差异有统计学意义（P=0.012），匹配后，两组患者肿瘤家族史差异有统计学意义（P=0.042）。倾向评分匹配前两组患者总体生存情况差异有统计学意义（P=0.014），倾向评分匹配后共纳入患者223例，所有患者都获得随访，随访时间为3~130个月，其中合并第二原发雌激素相关肿瘤组患者死亡8例，存活30例，中位生存时间为34.5个月，单一RCC组患者死亡57例，存活128例，中位生存时间为59.0个月。在随访时间内，合并第二原发雌激素相关肿瘤组的生存率均低于单一RCC组，两组总体生存情况相比较，差异有统计学意义（P=0.041）。结论：合并第二原发雌激素相关肿瘤的RCC并不少见，而肿瘤家族史可能使雌激素相关肿瘤患者再发RCC的风险升高。当合并第二原发雌激素相关肿瘤时，RCC患者的预后显著较单一RCC患者更差。

Clinical features of renal cell carcinoma carrying second primary estrogen-related tumors: propensity scorematching analysis

Background and purpose: With the progress of tumor diagnosis and treatment, the survival time of tumor patientscontinues to prolong, and there are increasing number of clinical reports about second primary carcinoma. The purpose of this studywas to investigate the clinical and pathological features of renal cell carcinoma (RCC) with second primary estrogen-related tumors.Methods: A total of 520 female RCC patients undergoing surgery in Fudan University Shanghai Cancer Center from Jan. 2008 toJan. 2019 were retrospectively enrolled, including 39 cases carrying second primary estrogen-related tumors and 481 cases with onlyprimary RCC. This study compared clinicopathological features in two groups, including age, body mass index (BMI), family historyof cancer, TNM staging and American Joint Committee on Cancer (AJCC) clinical staging. Propensity score matching (PSM) wasapplied to match two groups in 1:5 ratio. In addition, the Kaplan-Meier method was performed to assess the prognosis of the twogroups. Results: After construction of PSM algorithm, 38 patients carrying second primary estrogen-related tumor and 185 singleRCC patients were enrolled for analysis. Before PSM analysis, statistically significant difference was found between two groups infamily history of cancer (P=0.012). After performing PSM algorithm, there was still statistically significant difference between thetwo groups of patients (P=0.042). Before PSM analysis, statistically significant difference was found between two groups in overallsurvival (P=0.014). After performing PSM algorithm, a total of 223 female RCC patients were enrolled and followed up for 3-130months. Among the 38 patients carrying second primary estrogen-related tumor, 8 patients died, while 30 patients were still alive witha median survival time of 34.5 months. Among the 185 single RCC patients, 57 patients died, while 128 patients were still alive witha median survival time of 59.0 months. During the follow-up, the survival rate of patients carrying second primary estrogen-relatedtumor was always lower than that of single RCC patients. Statistically significant difference was found between two groups in overallsurvival (P=0.041). Conclusion: RCC patient carrying second primary estrogen-related tumor is not uncommon, and family historyof cancer may increase the risk of RCC in patient carrying second primary estrogen-related tumor. The prognosis of RCC patientcarrying second primary estrogen-related tumor is worse than that of patients with only RCC.