肾细胞癌核分级的预后价值：333例病例的多因素分析

Prognostic value of renal cell carcinoma nuclear grading: multivariate analysis of 333 cases.

作者信息

Ficarra V, Righetti R, Martignoni G, D'Amico A, Pilloni S, Rubilotta E, Malossini G, Mobilio G

机构信息

Department of Urology, University of Verona, Italy.

出版信息

Urol Int. 2001;67(2):130-4. doi: 10.1159/000050968.

DOI:10.1159/000050968

PMID:11490206

Abstract

OBJECTIVE

To evaluate the independent predictive value of the nuclear grading system according to Fuhrman in relation to the disease-specific survival of patients with renal clear cell carcinoma.

MATERIAL AND METHODS

333 patients who underwent radical nephrectomy for renal clear cell carcinoma between 1983 and 1999 were evaluated. In all patients we retrospectively studied nuclear grading, average tumor size, multifocality, pathologic stage of primary tumor, vein invasion, lymph node involvement and distant metastases. The Kaplan-Meier method was applied to evaluate disease-specific survival rates. The log rank test was used to compare survival curves and for univariate analysis. The Cox proportional hazards model was used for the multivariate analysis.

RESULTS

Histologic grade was G1 in 83 cases (25%), G2 in 117 cases (35%), G3 in 110 cases (33%) and G4 in 23 cases (7%). Our data showed that nuclear grading according to Fuhrman is related to medium tumor size (p < 0.0001), pathologic stage of cancer (p < 0.001), venous system invasion (p < 0.001), lymph node involvement (p < 0.001) and distant metastases (p < 0.001). The disease-specific survival after 5 and 10 years was 94 and 88%, respectively, in patients with G1, 86 and 75% in patients with G2, 59 and 40% in patients with G3 and 31% in patients with G4 (log rank p value < 0.0001). Multivariate analysis showed that nuclear grading by Fuhrman has a prognostic independent predictive value (hazard ratio = 1.8461, p = 0.002).

CONCLUSIONS

Nuclear grading is an important independent predictive factor of disease-specific survival in patients with renal cell carcinoma.

摘要

目的

评估根据富尔曼分级系统对肾透明细胞癌患者疾病特异性生存的独立预测价值。

材料与方法

对1983年至1999年间因肾透明细胞癌接受根治性肾切除术的333例患者进行评估。对所有患者，我们回顾性研究了核分级、平均肿瘤大小、多灶性、原发肿瘤的病理分期、静脉侵犯、淋巴结受累及远处转移情况。采用Kaplan-Meier法评估疾病特异性生存率。采用对数秩检验比较生存曲线并进行单因素分析。采用Cox比例风险模型进行多因素分析。

结果

组织学分级为G1的有83例（25%），G2的有117例（35%），G3的有110例（33%），G4的有23例（7%）。我们的数据显示，根据富尔曼分级的核分级与中等肿瘤大小（p < 0.0001）、癌症病理分期（p < 0.001）、静脉系统侵犯（p < 0.001）、淋巴结受累（p < 0.001）及远处转移（p < 0.001）相关。G1患者5年和10年的疾病特异性生存率分别为94%和88%，G2患者为86%和75%，G3患者为59%和40%，G4患者为31%（对数秩p值< 0.0001）。多因素分析显示，富尔曼核分级具有预后独立预测价值（风险比 = 1.8461，p = 0.002）。