肿瘤大小和DNA倍性在预测局限性肾细胞癌患者疾病进展中的独立价值。

Independent value of tumor size and DNA ploidy for the prediction of disease progression in patients with organ-confined renal cell carcinoma.

作者信息

Di Silverio F, Casale P, Colella D, Andrea L, Seccareccia F, Sciarra A

机构信息

Department of Urology "U.Bracci," University La Sapienza, Rome, Italy.

出版信息

Cancer. 2000 Feb 15;88(4):835-43. doi: 10.1002/(sici)1097-0142(20000215)88:4<835::aid-cncr14>3.0.co;2-j.

DOI:10.1002/(sici)1097-0142(20000215)88:4<835::aid-cncr14>3.0.co;2-j

PMID:10679653

Abstract

BACKGROUND

Greater than 20% of patients with apparently localized renal cell carcinoma (RCC) present with disease progression after surgery. The objective of the current study was to improve the ability of clinicians to predict prognosis in patients with localized RCC.

METHODS

The authors studied 154 patients with organ-confined RCC classified as pT1 to pT2-pN0-M0 who underwent radical nephrectomy. Follow-up ranged from 24-128 months (median, 72 months). Several morphologic parameters of the tumor were considered. DNA content was analyzed by flow cytometry and tumor size was determined from the surgical specimen. A Cox proportional hazards regression model was used to identify significant independent prognostic factors for disease progression.

RESULTS

At 5 and 10 years of follow-up, disease free survival was found to be 87% and 86%, respectively. Univariate analysis revealed that DNA content, Furhman grade, and tumor size had a statistically significant predictive value for disease progression, whereas, with regard to grade, the difference was significant only between patients with Grade 3 tumors and all other patients with Grade 1-2 tumors (P < 0. 0001). Although DNA content was found to correlate with tumor size (P < 0.0001), multivariate analysis showed that these were the only significant independent predictors of disease progression. The sum of DNA content and tumor size therefore was considered to distinguish separate risk groups. For a patient with diploid RCC, the risk of progression increased from 4% if the tumor size was 3 cm to 43% if the tumor size was 10 cm. For a patient with nondiploid RCC, this risk was 32% if the tumor size was 3 cm, increasing to 99% for tumors measuring 10 cm.

CONCLUSIONS

Stratification of organ-confined RCC according to tumor size and DNA content could possibly provide more information that could be useful in the selection of individuals with significantly different risks of disease progression.

摘要

背景

超过20%表面上局限期的肾细胞癌（RCC）患者术后会出现疾病进展。本研究的目的是提高临床医生预测局限性RCC患者预后的能力。

方法

作者研究了154例接受根治性肾切除术、病理分期为pT1至pT2-pN0-M0的器官局限性RCC患者。随访时间为24至128个月（中位数为72个月）。考虑了肿瘤的几个形态学参数。通过流式细胞术分析DNA含量，并从手术标本中确定肿瘤大小。使用Cox比例风险回归模型来确定疾病进展的显著独立预后因素。

结果

在随访5年和10年时，无病生存率分别为87%和86%。单因素分析显示，DNA含量、富尔曼分级和肿瘤大小对疾病进展具有统计学上显著的预测价值，而关于分级，仅3级肿瘤患者与所有其他1-2级肿瘤患者之间的差异具有显著性（P < 0.0001）。虽然发现DNA含量与肿瘤大小相关（P < 0.0001），但多因素分析表明，这些是疾病进展的仅有的显著独立预测因素。因此，DNA含量和肿瘤大小的总和被认为可区分不同的风险组。对于二倍体RCC患者，肿瘤大小为3 cm时进展风险为4%，肿瘤大小为10 cm时进展风险增至43%。对于非二倍体RCC患者，肿瘤大小为3 cm时该风险为32%，对于10 cm的肿瘤，该风险增至99%。