Hafez K S, Fergany A F, Novick A C
Department of Urology, Cleveland Clinic Foundation, Ohio 44195, USA.
J Urol. 1999 Dec;162(6):1930-3. doi: 10.1016/S0022-5347(05)68071-8.
We studied the impact of tumor size on patient survival and tumor recurrence following nephron sparing surgery for localized sporadic renal cell carcinoma. In addition, we evaluated the usefulness of the new TNM staging system in which T1 versus T2 tumor status is delineated by tumor size 7 or less versus more than 7 cm., respectively.
The results of nephron sparing surgery for localized sporadic renal cell carcinoma in 485 patients treated before 1997 were reviewed. Patients were divided into groups according to tumor size as 1--2.5 or less (142), 2--2.5 to 4.0 (168), 3--more than 4 to 7 (125) and 4--more than 7 cm (50). Mean postoperative followup was 47 months.
Overall and cancer specific 5-year survival for the entire series was 81 and 92%, respectively. Of 44 patients with recurrent renal cell carcinoma 16 (3.2%) had local recurrence and 28 (5.8%) had metastatic disease. There was no difference in 5-year cancer specific survival or tumor recurrence between groups 1 and 2 or groups 3 and 4. However, these outcome measures were significantly more favorable in groups 1 and 2 combined (tumors 4 cm. or less) compared to groups 3 and 4 combined (tumors more than 4 cm.) (p = 0.001).
Following nephron sparing surgery for localized sporadic renal cell carcinoma cancer-free survival is significantly better in patients with tumors 4 cm. or less compared to those with larger tumors. The usefulness of the current TNM staging system can be improved by subdividing T1 tumors into T1a (4 cm. or less) and T1b (4 to 7 cm.).
我们研究了保留肾单位手术治疗局限性散发性肾细胞癌后肿瘤大小对患者生存及肿瘤复发的影响。此外，我们评估了新的TNM分期系统的实用性，该系统中T1与T2肿瘤状态分别由肿瘤大小7cm及以下和大于7cm来界定。
回顾了1997年前接受治疗的485例局限性散发性肾细胞癌患者保留肾单位手术的结果。根据肿瘤大小将患者分为以下几组：1组——1至2.5cm及以下（142例），2组——2.5至4.0cm（168例），3组——4至7cm（125例），4组——大于7cm（50例）。术后平均随访47个月。
整个系列的总体5年生存率和癌症特异性5年生存率分别为81%和92%。在44例复发性肾细胞癌患者中，16例（3.2%）有局部复发，28例（5.8%）有转移性疾病。1组和2组之间或3组和4组之间的5年癌症特异性生存率或肿瘤复发率没有差异。然而，与3组和4组合并（肿瘤大于4cm）相比，1组和2组合并（肿瘤4cm及以下）的这些结果指标明显更优（p = 0.001）。
保留肾单位手术治疗局限性散发性肾细胞癌后，肿瘤4cm及以下的患者无癌生存率明显优于肿瘤较大的患者。通过将T1肿瘤细分为T1a（4cm及以下）和T1b（4至7cm），可提高当前TNM分期系统的实用性。
