Yoshimura Koji, Arai Yoichi, Fujimoto Hiroyuki, Nishiyama Hiroyuki, Ogura Keiji, Okino Takeshi, Ogawa Osamu
Department of Urology, Kurashiki Central Hospital, Kurashiki, Okayama, Japan.
Cancer. 2002 Jun 15;94(12):3150-6. doi: 10.1002/cncr.10609.
Pathologic T3 renal pelvic transitional cell carcinoma exhibits various patterns of invasion. The authors investigated the prognostic impact of three patterns of invasion of pT3 renal pelvic transitional cell carcinoma.
Of 212 patients who underwent surgery for renal pelvic transitional cell carcinoma, 70 with pT3 disease were eligible for the main analyses. The candidate predictors of prognosis included patient age, gender, lesion laterality, tumor grade, perioperative cisplatin-based systemic chemotherapy, lymph node involvement, vascular involvement, and patterns of invasion. Invasion patterns were classified as fat invasion, ductal involvement, or parenchymal invasion.
Mean postoperative followup was 33.5 months (range, 1-136 months). On univariate analysis, gender, lymph node involvement, vascular involvement, and extensive parenchymal invasion each had a significant impact on the cause specific survival rate. A multivariate analysis using Cox stepwise regression revealed that extensive parenchymal involvement was the strongest prognostic predictor (P = 0.0004, hazard ratio = 5.59). Lymph node involvement (P = 0.0175, hazard ratio = 3.14) and gender (P = 0.0361, hazard ratio = 2.42) were other weaker predictors. Statistically, pT3 disease without extensive parenchymal invasion had a prognosis similar to that of lower stage disease, and pT3 disease with extensive parenchymal invasion had a prognosis similar to that of pT4 disease.
Extensive parenchymal invasion has a strong prognostic impact in renal pelvic transitional cell carcinoma. pT3 disease should be subclassified into two separate entities, that with and that without extensive parenchymal invasion, in view of prognosis.
病理T3期肾盂移行细胞癌表现出多种浸润模式。作者研究了pT3期肾盂移行细胞癌三种浸润模式对预后的影响。
在212例行肾盂移行细胞癌手术的患者中，70例pT3期患者符合主要分析条件。预后的候选预测因素包括患者年龄、性别、病变侧别、肿瘤分级、围手术期基于顺铂的全身化疗、淋巴结受累、血管受累和浸润模式。浸润模式分为脂肪浸润、导管受累或实质浸润。
术后平均随访33.5个月（范围1 - 136个月）。单因素分析显示，性别、淋巴结受累、血管受累和广泛实质浸润对特定病因生存率均有显著影响。使用Cox逐步回归的多因素分析显示，广泛实质受累是最强的预后预测因素（P = 0.0004，风险比 = 5.59）。淋巴结受累（P = 0.0175，风险比 = 3.14）和性别（P = 0.0361，风险比 = 2.42）是其他较弱的预测因素。统计学上，无广泛实质浸润的pT3期疾病预后与较低分期疾病相似，而有广泛实质浸润的pT3期疾病预后与pT4期疾病相似。
广泛实质浸润对肾盂移行细胞癌预后有强烈影响。鉴于预后，pT3期疾病应分为两个独立的实体，即有广泛实质浸润和无广泛实质浸润的情况。
