乳头状肾细胞癌患者生存的预后因素：组织学分型和多灶性的意义

Prognostic factors for the survival of patients with papillary renal cell carcinoma: meaning of histological typing and multifocality.

作者信息

Mejean Arnaud, Hopirtean Vincent, Bazin Jean Philippe, Larousserie Frédérique, Benoit Hubert, Chrétien Yves, Thiounn Nicolas, Dufour Bertrand

机构信息

Department of Urology, Groupe Hospitalier Necker-Enfants Malades, 149 rue de Sevres, 75743 Paris Cedex 15, France.

出版信息

J Urol. 2003 Sep;170(3):764-7. doi: 10.1097/01.ju.0000081122.57148.ec.

DOI:10.1097/01.ju.0000081122.57148.ec

PMID:12913693

Abstract

PURPOSE

We identified prognostic factors of papillary renal cell carcinoma (PRCC) types 1 (PRCC1) and 2 (PRCC2).

MATERIALS AND METHODS

Between 1985 and 1998, 759 patients underwent surgery for renal cell carcinoma, of whom 88 (11.6%), including 69 males and 19 females with a mean age of 61.8 years (range 21.3 to 85.9) who had PRCC. Multifocality was defined as 2 or greater tumors separated by 10 mm or greater. Small basophilic cells defined PRCC1 and large eosinophilic cells defined PRCC2. Mean followup in 79 cases was 71.1 months (range 1 to 196.6). Survival rates were calculated and statistical analyses were done.

RESULTS

The 88 patients underwent radical nephrectomy (65) or conservative surgery (28, that is elective in 17 and imperative in 11). Mean tumor size was 62 mm (range 10 to 190) and 41% of lesions were multifocal, independent of PRCC size, stage, grade or type. Comparing the 56 PRCC1s (63.6%) to the 32 PRCC2s (36.4%) showed that PRCC2 grade and stage were significantly higher (p = 0.024 and 0.025, respectively). A total of 51 patients (64.6%) remained relapse-free and progression-free. Local relapses occurred only after imperative conservative surgery in 2 cases (2.5%). Of the 26 deaths 15 (4 PRCC 1 and 11 PRCC 2) were tumor associated. Mean survival was 26.6 months (range 1 to 112.5). The overall 10-year survival rate was 73% with PRCC1 and PRCC2 10-year rates of 80% and 59%, respectively (p <0.003). Univariate analysis identified stage (p <0.0001), grade (p <0.0001) and histological type (p <0.003) as prognostic factors. Multivariate analysis retained stage (p = 0.006) and grade (p = 0.004).

CONCLUSIONS

PRCC multifocality was not associated with stage, grade or histological type and it seems not to be an argument against conservative surgery. Univariate analysis of PRCC prognostic factors identified stage, grade and histological type but the latter was not retained on multivariate analysis.

摘要

目的

我们确定了1型（PRCC1）和2型（PRCC2）乳头状肾细胞癌的预后因素。

材料与方法

1985年至1998年间，759例患者接受了肾细胞癌手术，其中88例（11.6%）为PRCC患者，包括69例男性和19例女性，平均年龄61.8岁（范围21.3至85.9岁）。多灶性定义为两个或更多肿瘤，其间距离10mm或更大。小嗜碱性细胞定义为PRCC1，大嗜酸性细胞定义为PRCC2。79例患者的平均随访时间为71.1个月（范围1至196.6个月）。计算生存率并进行统计分析。

结果

88例患者接受了根治性肾切除术（65例）或保守手术（28例，其中17例为选择性手术，11例为必要手术）。平均肿瘤大小为62mm（范围10至190mm），41%的病变为多灶性，与PRCC的大小、分期、分级或类型无关。比较56例PRCC1（63.6%）和32例PRCC2（36.4%）发现，PRCC2的分级和分期显著更高（分别为p = 0.024和0.025）。共有51例患者（64.6%）无复发和进展。局部复发仅发生在2例必要保守手术后（2.5%）。在26例死亡患者中，15例（4例PRCC1和11例PRCC2）与肿瘤相关。平均生存期为26.6个月（范围1至112.5个月）。PRCC的总体10年生存率为73%，PRCC1和PRCC2的10年生存率分别为80%和59%（p <0.003）。单因素分析确定分期（p <0.0001）、分级（p <0.0001）和组织学类型（p <0.003）为预后因素。多因素分析保留了分期（p = 0.006）和分级（p = 0.004）。