Jeon S H, Chang S G, Kim J I
Department of Urology, School of Medicine, Kyung Hee University, Seoul, Korea.
Anticancer Res. 1999 Nov-Dec;19(6C):5593-7.
Five-year overall survival after radical nephrectomy in pT3N0M0 renal cell carcinoma is 35-50%. In light of immunotherapy, which has shown some activity in advanced diseases with increasing efficacy in limited metastatic invasion, we decided to explore the theoretical advantage of adjuvant immunotherapy in radically resected stage pT3N0M0 renal cell carcinoma. We studied several factors including tumor size, nuclear grade, mean nuclear area and expression of p53 protein to find out which factor is concerned with disease progression. A total of 10 patients with pT3N0M0 RCC who received radical nephrectomy from February 1992 to April 1999 were randomly assigned to receive treatment with either interferon-alpha alone or interferon-alpha plus vinblastine. Eight patients with pT3N0M0 RCC who received only radical nephrectomy from January 1984 to February 1993 were analyzed and the results were compared with the first group. Six out of 10 (60%) patients in the adjuvant immunotherapy group are alive with no evidence of disease. Metastases were documented in 4 patients (40%) with a median interval to progression of 17.5 months. All of them died of tumor. In the surgery only group, 5 out of 8 patients (62.5%) are still alive with no evidence of disease. Two patients (25%) developed distant metastases and both of them died of tumor. The median progression interval was 11 months. There were no statistical differences in time to progression and survival rate between the two groups. In the univariate analysis using a log-rank test, the expression of p53 protein seemed to be associated with shorter survival (p = 0.0591). However, in the multivariate analysis using Cox's proportional hazard model, no parameter had significant independent prognostic value. We concluded that adjuvant immunotherapy did not improve the survival of patients with pT3N0M0 RCC. Furthermore, we failed to find significant prognostic factors in patients with pT3N0M0 RCC.
pT3N0M0期肾细胞癌根治性肾切除术后的5年总生存率为35% - 50%。鉴于免疫疗法在晚期疾病中已显示出一定活性，且在有限转移侵袭情况下疗效不断提高，我们决定探讨辅助免疫疗法在根治性切除的pT3N0M0期肾细胞癌中的理论优势。我们研究了几个因素，包括肿瘤大小、核分级、平均核面积和p53蛋白表达，以找出与疾病进展相关的因素。1992年2月至1999年4月期间接受根治性肾切除术的10例pT3N0M0期肾细胞癌患者被随机分配接受单独干扰素-α治疗或干扰素-α加长春碱治疗。分析了1984年1月至1993年2月期间仅接受根治性肾切除术的8例pT3N0M0期肾细胞癌患者，并将结果与第一组进行比较。辅助免疫治疗组的10例患者中有6例（60%）存活且无疾病证据。4例患者（40%）记录有转移，进展的中位间隔时间为17.5个月。他们均死于肿瘤。仅手术组的8例患者中有5例（62.5%）仍存活且无疾病证据。2例患者（25%）发生远处转移，均死于肿瘤。进展的中位间隔时间为11个月。两组之间在进展时间和生存率方面无统计学差异。在使用对数秩检验的单变量分析中，p53蛋白表达似乎与较短生存期相关（p = 0.0591）。然而，在使用Cox比例风险模型的多变量分析中，没有参数具有显著的独立预后价值。我们得出结论，辅助免疫疗法并未改善pT3N0M0期肾细胞癌患者的生存率。此外，我们未能在pT3N0M0期肾细胞癌患者中找到显著的预后因素。
