Scilletta B, Di Carlo I, Lombardo R, Aronica G, Di Stefano F, Racalbuto A, Puleo S
I Clinica Chirurgica, Università degli Studi, Catania.
Minerva Chir. 1999 Mar;54(3):157-62.
Image diagnosis of kidney neoplasms allows good preoperative staging using the TNM system, but surgical management cannot be based on these data because a tumour apparently confined to the kidney may have produced metastasis in extraregional lymph nodes.
Thirty-three patients with renal carcinoma were observed over a seven-year period. Preoperative staging using the TNM system was performed and then compared with postoperative staging. Radical nephrectomy and regional lymphadenectomy were performed in all patients. Extensive lymphadenectomy was undertaken in 10 cases presenting neoplasms larger than 10 cm. At the preoperative assessment, 20 patients were stage T2, 13 stage T3, for factor N six were N1, two M1; postoperative staging confirmed T2 in 15 cases, whereas five T2 became T3. After postoperative staging, the N1 patients increased from 6 to 13. Fifteen patients were at Robson's stage II, four at stage IIA, twelve IIIB and two stage IV.
The 5-year survival rate was 63.2%.
The authors conclude that from an analysis of the correlation between tumour size and lymph node metastasis it can be seen that low T values do not represent grounds for conservative treatment.
肾脏肿瘤的影像诊断可使用TNM系统进行良好的术前分期，但手术治疗不能仅基于这些数据，因为表面上局限于肾脏的肿瘤可能已在区域外淋巴结发生转移。
在七年时间里观察了33例肾癌患者。采用TNM系统进行术前分期，然后与术后分期进行比较。所有患者均行根治性肾切除术和区域淋巴结清扫术。对10例肿瘤大于10 cm的患者进行了广泛淋巴结清扫术。术前评估时，20例患者为T2期，13例为T3期，N分期中6例为N1，2例为M1；术后分期证实15例为T2期，而5例T2期变为T3期。术后分期后，N1患者从6例增加到13例。15例患者处于罗布森分期II期，4例处于IIA期，12例处于IIIB期，2例处于IV期。
5年生存率为63.2%。
作者得出结论，通过对肿瘤大小与淋巴结转移之间相关性的分析可以看出，低T值并非保守治疗的依据。
