Frank Igor, Blute Michael L, Cheville John C, Lohse Christine M, Weaver Amy L, Zincke Horst
Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, Minnesota, USA.
J Urol. 2002 Dec;168(6):2395-400. doi: 10.1016/S0022-5347(05)64153-5.
Currently outcome prediction in renal cell carcinoma is largely based on pathological stage and tumor grade. We developed an outcome prediction model for patients treated with radical nephrectomy for clear cell renal cell carcinoma, which was based on all available clinical and pathological features significantly associated with death from renal cell carcinoma.
We identified 1,801 adult patients with unilateral clear cell renal cell carcinoma treated with radical nephrectomy between 1970 and 1998. Clinical features examined included age, sex, smoking history, and signs and symptoms at presentation. Pathological features examined included 1997 TNM stage, tumor size, nuclear grade, histological tumor necrosis, sarcomatoid component, cystic architecture, multifocality and surgical margin status. Cancer specific survival was estimated using the Kaplan-Meier method. Cox proportional hazards regression models were used to test associations between features studied and outcome. The selection of features included in the multivariate model was validated using bootstrap methodology.
Mean followup was 9.7 years (range 0.1 to 31). Estimated cancer specific survival rates at 1, 3, 5, 7 and 10 years were 86.6%, 74.0%, 68.7%, 63.8% and 60.0%, respectively. Several features were multivariately associated with death from clear cell renal cell carcinoma, including 1997 TNM stage (p <0.001), tumor size 5 cm. or greater (p <0.001), nuclear grade (p <0.001) and histological tumor necrosis (p <0.001).
In patients with clear cell renal cell carcinoma 1997 TNM stage, tumor size, nuclear grade and histological tumor necrosis were significantly associated with cancer specific survival. We present a scoring system based on these features that can be used to predict outcome.
目前，肾细胞癌的预后预测主要基于病理分期和肿瘤分级。我们为接受根治性肾切除术的透明细胞肾细胞癌患者开发了一种预后预测模型，该模型基于所有与肾细胞癌死亡显著相关的可用临床和病理特征。
我们确定了1970年至1998年间1801例接受根治性肾切除术的单侧透明细胞肾细胞癌成年患者。检查的临床特征包括年龄、性别、吸烟史以及就诊时的体征和症状。检查的病理特征包括1997年TNM分期、肿瘤大小、核分级、组织学肿瘤坏死、肉瘤样成分、囊性结构、多灶性和手术切缘状态。采用Kaplan-Meier法估计癌症特异性生存率。使用Cox比例风险回归模型检验所研究特征与预后之间的关联。使用自助法验证多变量模型中纳入特征的选择。
平均随访9.7年（范围0.1至31年）。1年、3年、5年、7年和10年的估计癌症特异性生存率分别为86.6%、74.0%、68.7%、63.8%和60.0%。几个特征与透明细胞肾细胞癌死亡多变量相关，包括1997年TNM分期（p<0.001）、肿瘤大小5cm或更大（p<0.001）、核分级（p<0.001）和组织学肿瘤坏死（p<0.001）。
在透明细胞肾细胞癌患者中，1997年TNM分期、肿瘤大小、核分级和组织学肿瘤坏死与癌症特异性生存率显著相关。我们基于这些特征提出了一个评分系统，可用于预测预后。
