Zielinski H, Szmigielski S, Petrovich Z
Department of Clinical Urology, MMA Central Clinical Hospital, Warsaw, Poland.
Am J Clin Oncol. 2000 Feb;23(1):6-12. doi: 10.1097/00000421-200002000-00002.
A series of 474 patients with renal cell carcinoma (RCC), who had radical nephrectomy during a period of 15 years, was studied to assess the prognostic significance of various pathologic parameters (tumor stage [pT], lymph node status, metastasis, tumor grade, venous involvement) and value of preoperative embolization of renal artery. There were: 20 (4%) pT1, 204 (43%) pT2, 245 (52%) pT3, and 5 (1%) pT4 patients. All 474 patients underwent nephrectomy including a group of 118 (25%) patients (24 pT2, 90 pT3, and 4 pT4) who underwent preoperative embolization of the renal artery. To compare treatment outcomes in embolized patients with RCC, a group of 116 (24%) nonembolized patients with RCC was selected. This group was matched for sex, age, stage, tumor size, and tumor grade, with the embolized patients (p<0.01). All important prognostic factors were studied as to their influence on survival by the treatment group. The overall 5- and 10-year survival was 62% and 47%, respectively. The 5- and 10-year survival rates were significantly better (p<0.01) for patients with pT2 than for those with pT3 tumors (79% vs. 50% and 59% vs. 35%, respectively). Involvement of regional lymph nodes (N+) was an important prognostic factor for survival in patients with pT3 tumors. The 5-year survival for pT3 N+ was 39%, compared with 66% in those with pT3N0 (p<0.01). Preoperative embolization was also an important factor influencing survival. The overall 5- and 10-year survival for 118 patients embolized before nephrectomy was 62% and 47%, respectively, and it was 35% and 23%, respectively, for the matched group of 116 patients treated with surgery alone (p = 0.01). The most important finding of this study was an apparent importance of preoperative embolization in improving patients' survival. This finding needs to be interpreted with caution and confirmed in a prospective randomized trial.
对474例在15年期间接受根治性肾切除术的肾细胞癌（RCC）患者进行了研究，以评估各种病理参数（肿瘤分期[pT]、淋巴结状态、转移、肿瘤分级、静脉受累情况）的预后意义以及术前肾动脉栓塞的价值。其中有：20例（4%）pT1期、204例（43%）pT2期、245例（52%）pT3期和5例（1%）pT4期患者。所有474例患者均接受了肾切除术，其中118例（25%）患者（24例pT2期、90例pT3期和4例pT4期）接受了术前肾动脉栓塞。为了比较接受栓塞治疗的RCC患者的治疗结果，选择了116例（24%）未接受栓塞治疗的RCC患者。该组在性别、年龄、分期、肿瘤大小和肿瘤分级方面与接受栓塞治疗的患者相匹配（p<0.01）。研究了所有重要预后因素对治疗组生存的影响。总体5年和10年生存率分别为62%和47%。pT2期患者的5年和10年生存率明显高于pT3期肿瘤患者（分别为79%对50%和59%对35%，p<0.01）。区域淋巴结受累（N+）是pT3期肿瘤患者生存的重要预后因素。pT3 N+患者的5年生存率为39%，而pT3N0患者为66%（p<0.01）。术前栓塞也是影响生存的重要因素。118例肾切除术前接受栓塞治疗的患者总体5年和10年生存率分别为62%和47%，而仅接受手术治疗的116例匹配患者组分别为35%和23%（p = 0.01）。本研究最重要的发现是术前栓塞在改善患者生存方面具有明显重要性。这一发现需要谨慎解读，并在前瞻性随机试验中得到证实。
