The predictive effect of adjusted Utrecht staging criteria on efficacy of mTOR inhibitors in TSC-AML patients
10.3760/cma.j.cn112330-20221214-00667
- VernacularTitle:调整Utrecht分级对TSC-AML患者接受mTOR抑制剂治疗效果的预测作用
- Author:
Wenda WANG
1
;
Dongxu QIU
;
Zhangcheng LIAO
;
Hanzhong LI
;
Yushi ZHANG
Author Information
1. 中国医学科学院 北京协和医学院 北京协和医院泌尿外科，北京 100730
- Keywords:
Tuberous sclerosis;
Angiomyolipoma;
Therapeutic effect;
Predict
- From:
Chinese Journal of Urology
2023;44(10):731-735
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the predictive effect of adjusted Utrecht staging criteria on efficacy of mammalian target of rapamycin (mTOR) inhibitors in patients with tuberous sclerosis-associated renal angiomyolipoma (TSC-AML).Methods:In this study, 39 adult patients with TSC-AML who attended the Peking Union Medical College Hospital from December, 2014 to December, 2020 were retrospectively analyzed, and were divided into 4 groups based on Utrecht staging criteria: Group 1, Utrecht staging ≤ stage 5, all AMLs <5 cm( n=6); Group 2, stage 6 with at least one AML ≥5 cm and normal renal anatomy( n=14); Group 3, stage 6 with at least one AML ≥5 cm and recognizable renal anatomy( n=10); Group 4, stage with at least one AML ≥5 cm and unrecognizable renal anatomy ( n=9). The mean age of patients in the 4 groups were 27.33±7.84, 28.64±12.36, 31.10±5.88 and 29.11±7.15 ( P=0.869). No statistic difference in gender was found among the different groups ( P=0.233). The mean maximum diameters of AML in the four groups were (3.54±0.52)cm, (8.11±2.08)cm, (11.58±4.60)cm and (17.08±3.61)cm, respectively( P<0.01). The mean levels of creatinine were (80.17±16.01)μmol/L, (76.36±18.72)μmol/L, (76.10±27.61)μmol/L and (71.89±18.66)μmol/L in the four groups( P=0.900). The numbers of patients with positive urine protein were 2, 3, 8 and 2 ( P=0.023). All the patients took Everolimus 10mg orally per day for at least 3 months. Differences in maximum AML shrinkage rate, creatinine level, severity of urine protein and microscopic hematuria were compared between the groups. Results:As AML severity increased, the shrinkage rates decreased significantly in turn [Group 1: (76.06±13.16)%, Group 2: (64.92±16.33)%, Group 3: (55.30±20.49)%, Group 4: (43.73±20.61)%, P=0.009]. After treatment, creatinine levels increased in all groups[Group 1: (8.50±7.61)μmol/L, Group 2: (5.71±8.54)μmol/L, Group 3: (7.70±7.18)μmol/L, Group 4: (6.11±7.04)μmol/L], but there was no significant difference among groups (P=0.856). Moreover the increase in urine protein worsened with the degree of severity (Group 1∶3, Group 2∶4, Group 3∶6, Group 4∶9, P=0.014). Conclusions:The adjusted Utrecht staging criteria could predict the maximum AML shrinkage rate and urine protein increase in TSC-AML patients with treatment of mTOR inhibitors.
