显微镜下静脉侵犯：肾细胞癌的一个预后因素。

Microscopic venous invasion: a prognostic factor in renal cell carcinoma.

作者信息

Lang H, Lindner V, Saussine C, Havel D, Faure F, Jacqmin D

机构信息

Department of Urology, Hôpitaux Universitaires de Strasbourg, France.

出版信息

Eur Urol. 2000 Nov;38(5):600-5. doi: 10.1159/000020338.

DOI:10.1159/000020338

PMID:11096243

Abstract

OBJECTIVE

Microscopic venous invasion (MVI) is characterized by local destruction of the endothelium by a tumor. The prognostic value of MVI in renal cell carcinoma (RCC) is not well established.

MATERIALS AND METHODS

From 1980 until 1990, 255 patients (169 men and 86 women), aged 16-87 (mean 60) years were treated by radical nephrectomy for N0M0 RCC. There were 9 pT1, 163 pT2, 30 pT3a, 34 pT3b, and 19 pT3ab (TNM 1992). The median follow-up time was 74 months. MVI was determined by a double-blind histological study with immunohistochemical staining.

RESULTS

MVI was noted in 74 patients (29%). MVI significantly increased metastatic progression (p = 0.003). Only stage and Fuhrman's grade were significant factors for metastatic progression in a multivariate analysis. MVI decreased the actuarial survival rates at 1 year (p = 0.01), but not significantly at 5 and 10 years. MVI and non-MVI survival curves were statistically different with the Peto/Wilcoxon (p = 0.04) and Gehan/Wilcoxon (p = 0.03) tests, but not with the log rank test (p = 0.06). MVI decreased survival in cases with a tumor size of 10 cm or more, capsular invasion, macroscopic venous invasion, stage pT3ab, sarcomatoid cell carcinoma and Fuhrman's grade IV. Only the stage was a significant factor for survival in a multivariate analysis.

CONCLUSION

In RCC, MVI is related to cancer progression and survival, but probably not as an independent prognostic factor.

摘要

目的

显微镜下静脉侵犯（MVI）的特征是肿瘤对内皮细胞的局部破坏。MVI在肾细胞癌（RCC）中的预后价值尚未完全明确。

材料与方法

1980年至1990年，对255例年龄在16 - 87岁（平均60岁）的N0M0期RCC患者行根治性肾切除术，其中男性169例，女性86例。病理分期为9例pT1、163例pT2、30例pT3a、34例pT3b和19例pT3ab（TNM 1992分期）。中位随访时间为74个月。MVI通过双盲组织学研究及免疫组化染色确定。

结果

74例患者（29%）存在MVI。MVI显著增加转移进展（p = 0.003）。多因素分析中，只有分期和Fuhrman分级是转移进展的显著因素。MVI使1年精算生存率降低（p = 0.01），但5年和10年时无显著差异。MVI和非MVI生存曲线经Peto/Wilcoxon检验（p = 0.04）和Gehan/Wilcoxon检验（p = 0.03）有统计学差异，但对数秩检验无差异（p = 0.06）。肿瘤大小≥10 cm、有包膜侵犯、肉眼静脉侵犯、pT3ab分期、肉瘤样细胞癌及Fuhrman分级为IV级的病例中，MVI降低生存率。多因素分析中只有分期是生存的显著因素。