رسالة جامعية
Treatment selection in metastatic renal cell carcinoma : Towards an individualised approach
| العنوان: | Treatment selection in metastatic renal cell carcinoma : Towards an individualised approach |
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| المؤلفون: | Stenman, Maria |
| بيانات النشر: | Uppsala universitet, Experimentell och klinisk onkologi Uppsala University Uppsala |
| سنة النشر: | 2019 |
| المجموعة: | Uppsala University: Publications (DiVA) |
| مصطلحات موضوعية: | rcc, renal cell carcinoma, kidney cancer, stereotactic radiotherapy, srt, stereotactic body radiotherapy, sbrt, gamma knife radiosurgery, gkrs, stereotactic radiosurgery, srs, radiotherapy, overall survival, prognostic factor, papillary, Cancer and Oncology, Cancer och onkologi |
| الوصف: | Renal cell carcinoma (RCC), a common malignancy worldwide, affects 1200 new patients yearly in Sweden. Metastatic RCC (mRCC) develops in one in three and is commonly incurable. Clear cell histology dominates followed by papillary histology. The mainstay of mRCC treatment is targeted agents (TA) against aberrantly signalling pro-angiogenic tyrosine kinase receptors, and recently also immune checkpoint inhibitors. Local metastatic therapy with stereotactic radiotherapy (SRT) or surgical metastasectomy may be considered for oligometastatic disease. The aims of this thesis were (1) to identify clinically relevant factors useful for prognostication in real-world patients with mRCC treated in the TA era, (2) to deepen the understanding of papillary mRCC, and (3) to evaluate local metastatic therapy in mRCC. The papers of this thesis were based on retrospective data from regional databases or patient records from 2005 and onwards to reflect the contemporary therapeutic landscape. Paper I was a single-centre study analysing inflammatory blood and clinical parameters in relation to overall survival (OS) in mRCC (n=84). Median OS (mOS) was 20 months. Hypoalbuminemia was a negative prognostic factor (HR 2.7), independently of patient performance status (PS) or Memorial Sloan Kettering Cancer Center risk criteria. Paper II included solely patients with papillary mRCC (n=86) treated at three centres. mOS was 11 months. Age ≥60 years (HR 2.2), ≥3 metastatic sites (HR 2.7), and Eastern Cooperative Oncology Group (ECOG) PS ≥2 vs 1 (HR 3.0) were independently associated with worse OS. Paper III included mRCC patients treated with local metastatic therapy (n=117). Survival was similar irrespective of SRT or surgical metastasectomy with a mOS of 51 months. Treatment with TA in close proximity to local therapy was well tolerated. ECOG PS 1 vs 0 (HR 2.9), intracranial treatment (HR 1.8), and watchful waiting ≥18 months prior to treatment (HR 0.3) were independently prognostic. Paper IV was a follow-up of patients with ccRCC brain ... |
| نوع الوثيقة: | doctoral or postdoctoral thesis |
| وصف الملف: | application/pdf |
| اللغة: | English |
| ردمك: | 978-91-513-0724-4 91-513-0724-3 |
| العلاقة: | Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, 1651-6206; 1590; http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-390138Test; urn:isbn:978-91-513-0724-4 |
| الإتاحة: | http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-390138Test |
| حقوق: | info:eu-repo/semantics/openAccess |
| رقم الانضمام: | edsbas.EF4ECA9A |
| قاعدة البيانات: | BASE |
| ردمك: | 9789151307244 9151307243 |
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