Cheville J C, Blute M L, Zincke H, Lohse C M, Weaver A L
Departments of Pathology and Laboratory Medicine, Urology and Biostatistics, Mayo Clinic, Rochester, Minnesota, USA.
J Urol. 2001 Aug;166(2):453-6. doi: 10.1016/s0022-5347(05)65962-9.
The features predictive of aggressive behavior in stage pT1 conventional (clear cell) renal cell carcinoma are not completely known. We evaluated pathological features in a large series of stage pT1 conventional renal cell carcinoma cases and examined the association of these features with cancer specific survival.
Patients with solitary stage pT1 conventional renal cell carcinoma who underwent radical nephrectomy between 1970 and 1997 were eligible for study. For each of the 46 patients who died of renal cell carcinoma we selected a stratified random sample of at least 3 year matched controls who were still alive or dead of other causes. The study included 277 patients. We evaluated patient age at nephrectomy, sex, tumor size, Fuhrman grade, necrosis and sarcomatoid component. Univariate and multivariate Cox proportional hazards models were fit to assess the features associated with cancer specific survival.
Multivariate modeling revealed that tumor size, Fuhrman grade and necrosis were jointly significantly associated with cancer specific survival. Of the 4.5, 5 and 6 cm. tumor size cutoffs examined on univariate analysis a cutoff of 5 cm. or greater was most predictive of cancer specific survival.
In stage pT1 conventional renal cell carcinoma Fuhrman grade, tumor necrosis and tumor size together were jointly significantly associated with cancer specific survival. Specifically of the tumor size cutoffs analyzed the 5 cm. cutoff was most predictive of cancer specific survival.
pT1期传统型（透明细胞）肾细胞癌侵袭性行为的预测特征尚不完全清楚。我们评估了大量pT1期传统型肾细胞癌病例的病理特征，并研究了这些特征与癌症特异性生存的相关性。
1970年至1997年间接受根治性肾切除术的孤立性pT1期传统型肾细胞癌患者符合研究条件。对于46例死于肾细胞癌的患者，我们为每位患者选择了至少3年匹配的对照组，这些对照组仍存活或死于其他原因。该研究包括277例患者。我们评估了肾切除时的患者年龄、性别、肿瘤大小、Fuhrman分级、坏死和肉瘤样成分。采用单因素和多因素Cox比例风险模型评估与癌症特异性生存相关的特征。
多因素建模显示，肿瘤大小、Fuhrman分级和坏死与癌症特异性生存显著相关。在单因素分析中检查的4.5、5和6厘米肿瘤大小临界值中，5厘米或更大的临界值对癌症特异性生存的预测性最强。
在pT1期传统型肾细胞癌中，Fuhrman分级、肿瘤坏死和肿瘤大小共同与癌症特异性生存显著相关。具体而言，在所分析的肿瘤大小临界值中，5厘米临界值对癌症特异性生存的预测性最强。
