Ljungberg B, Landberg G, Alamdari F I
Department of Surgical and Perioperative Science, Urology and Andrology, Umeå University, Sweden.
Scand J Urol Nephrol. 2000 Aug;34(4):246-51. doi: 10.1080/003655900750041979.
The indications for nephrectomy in patients with metastatic renal cell carcinoma remain controversial. A number of variables were analysed to identify factors that might predict the survival time, and these factors were used to obtain guidance as to which patients might benefit from palliative nephrectomy.
We reviewed the medical records for 106 consecutive patients with primary metastatic renal cell carcinoma, including clinicopathological factors, routine laboratory data and metastatic spread. The association of the different factors to survival time was evaluated by univariate and multivariate analysis.
A number of factors correlated to survival time in univariate analysis, including solitary versus multiple metastases, serum albumin and DNA ploidy, but after Cox multivariate analysis their significance was lost. The remaining independent prognostic factors were performance status, number of metastatic sites, erythrocyte sedimentation rate (ESR), calcium in serum and vein invasion with tumour thrombus formation. The factors with no association to survival time were the metastatic sites, tumour size and nuclear grade. Patients treated with nephrectomy had a significantly longer survival time than those who did not undergo nephrectomy (p < 0.001). None of the 28 patients who did not undergo nephrectomy survived for 2 years, compared with 38 of the 78 patients who were nephrectomized.
Patients who can be expected to survive longer, and who might be recommended for nephrectomy despite metastatic disease, would have the following independent factors: a good performance status, metastases limited to one organ, low ESR, normal calcium in serum and no tumour thrombus formation.
转移性肾细胞癌患者肾切除术的适应证仍存在争议。分析了多个变量以确定可能预测生存时间的因素，并利用这些因素为哪些患者可能从姑息性肾切除术中获益提供指导。
我们回顾了106例连续的原发性转移性肾细胞癌患者的病历，包括临床病理因素、常规实验室数据和转移扩散情况。通过单因素和多因素分析评估不同因素与生存时间的相关性。
在单因素分析中，一些因素与生存时间相关，包括单发转移与多发转移、血清白蛋白和DNA倍体，但在Cox多因素分析后，它们的意义消失了。其余独立的预后因素为体能状态、转移部位数量、红细胞沉降率（ESR）、血清钙和静脉侵犯伴肿瘤血栓形成。与生存时间无关的因素为转移部位、肿瘤大小和核分级。接受肾切除术的患者生存时间明显长于未接受肾切除术的患者（p < 0.001）。28例未接受肾切除术的患者中无一例存活2年，而78例接受肾切除术的患者中有38例存活。
预期生存时间较长且尽管有转移性疾病仍可能被推荐进行肾切除术的患者，具有以下独立因素：良好的体能状态、转移局限于一个器官、低ESR、血清钙正常且无肿瘤血栓形成。
