title: [Relationship between treatment-related hypertension and therapeutic efficacy of vascular endothelial growth factor receptor tyrosine kinase inhibitors in metastatic renal cell carcinoma].
abstract: OBJECTIVE
  Vascular endothelial growth factor receptor-tyrosine kinase inhibitors (VEGFR-TKIs) are widely used for the treatment of metastatic renal cell carcinoma (mRCC). The aim of this study was to investigate the association between treatment-related hypertension and the therapeutic efficacy of VEGFR-TKIs.
  
  
  METHODS
  Clinical data of 155 mRCC patients treated with VEGFR-TKIs at the Cancer Hospital of Chinese Academy of Medical Sciences from 2006 to 2014 were retrospectively analyzed. All patients received first-line TKI therapy. Among them, 69 patients were treated with sunitinib, 14 cases with pazopanib, and 51 cases with fazotinib. Kaplan-Meier curves were used to evaluate the survival of the patients.
  
  
  RESULTS
  The median survival for the whole group (n=155) was 36.2 months. Among the 98 (63.2%) patients who developed hypertension, 9 patients (5.8%) were evaluated as grade Ⅰ, 54 (34.8%) as grade Ⅱ and 35 (22.6%) as grade Ⅲ, and there was no patient with grade Ⅳ hypertension. The occurrence of TKI-related hypertension was correlated with age and MSKCC score (P<0.05), while not significantly correlated with gender, nephrectomy, T stage, number of metastases, lung metastasis or sunitinib treatment (P>0.05 for all). For the whole group (n=155), the therapeutic efficacy rate was 43.2% (67/155), the median progression-free survival (PFS) was 12.0 months, and the median overall survival (OS) was 36.2 months. The response rate (RR) was 26.3% (15/57) in patients with normal blood pressure and 53.1% (52/98) in patients with hypertension (P=0.001). The median PFS was 7.1 months in the cases with normal blood pressure and 13.8 months in patients with hypertension (P=0.032). The response rates were 33.3% (3/9), 51.9% (28/54) and 60.0% (21/35) in patients with grade Ⅰ, Ⅱ and Ⅲ hypertension (P=0.006). The median PFS was 7.1, 9.7, and 12.0 and 19.5 months in patients with normal blood pressure, and patients with grade Ⅰ, Ⅱ and Ⅲ hypertension, respectively (P=0.039). Both univariant and multivariant analyses indicated that treatment-related hypertension is an important predictive factor for the efficacy of VEGFR-TKIs therapy.
  
  
  CONCLUSIONS
  Hypertension might be an effective predictive factor for efficacy of VEGFR-TKIs therapy in mRCC patients. Large-sample studies are warranted to further prove these results.
authors.affiliation: Department of Medical Oncology, National Cancer Certer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
authors.forename: Y
authors.initials: Y
authors.lastname: Song
authors.affiliation: Department of Medical Oncology, National Cancer Certer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
authors.forename: C X
authors.initials: CX
authors.lastname: Du
authors.affiliation: Department of Medical Oncology, National Cancer Certer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
authors.forename: W
authors.initials: W
authors.lastname: Zhang
authors.affiliation: Department of Medical Oncology, National Cancer Certer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
authors.forename: Y K
authors.initials: YK
authors.lastname: Sun
authors.affiliation: Department of Medical Oncology, National Cancer Certer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
authors.forename: L
authors.initials: L
authors.lastname: Yang
authors.affiliation: Department of Medical Oncology, National Cancer Certer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
authors.forename: C X
authors.initials: CX
authors.lastname: Cui
authors.affiliation: Department of Medical Oncology, National Cancer Certer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
authors.forename: Yihebali
authors.initials: Y
authors.lastname: Chi
authors.affiliation: Department of Medical Oncology, National Cancer Certer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
authors.forename: A P
authors.initials: AP
authors.lastname: Zhou
authors.affiliation: Department of Medical Oncology, National Cancer Certer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
authors.forename: J W
authors.initials: JW
authors.lastname: Wang
authors.affiliation: Department of Medical Oncology, National Cancer Certer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
authors.forename: Y
authors.initials: Y
authors.lastname: Sun
mesh_terms: D002292:Carcinoma, Renal Cell; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D006973:Hypertension; D007191:Indazoles; D007211:Indoles; D007680:Kidney Neoplasms; D008297:Male; D009362:Neoplasm Metastasis; D009392:Nephrectomy; D047428:Protein Kinase Inhibitors; D011743:Pyrimidines; D011758:Pyrroles; D012189:Retrospective Studies; D013449:Sulfonamides; D000077210:Sunitinib; D042461:Vascular Endothelial Growth Factor A
chemical_list: D007191:Indazoles; D007211:Indoles; D047428:Protein Kinase Inhibitors; D011743:Pyrimidines; D011758:Pyrroles; D013449:Sulfonamides; D042461:Vascular Endothelial Growth Factor A; C516667:pazopanib; D000077210:Sunitinib