Palapattu Ganesh S, Pantuck Allan J, Dorey Fred, Said Jonathon W, Figlin Robert A, Belldegrun Arie S
Department of Urology, David Geffen School of Medicine at UCLA, University of California-Los Angeles, 10833 Le Conte Avenue, los Angeles, CA 90095-1738, USA.
J Urol. 2003 Sep;170(3):768-72; discussion 772. doi: 10.1097/01.ju.0000082580.13597.a2.
To define further the prognostic impact of urothelial invasion in renal cell carcinoma (RCC) we examined the outcome in patients presenting to our institution with kidney cancer treated with nephrectomy.
We reviewed the medical records of 895 patients with RCC who were treated with nephrectomy between 1989 and 1999. Median followup was 31 months. Kaplan-Meier survival curves were constructed with respect to 1997 TNM stage, Fuhrman grade and University of California-Los Angeles Integrated Staging System stage, comparing patients with and without collecting system invasion. Univariate and multivariate analyses were performed. Overall survival was defined as time from nephrectomy to time of death or last followup.
Of the 895 patients 124 (14%) demonstrated collecting system invasion. Patients with collecting system invasion were more likely to be symptomatic and have associated metastases and/or positive nodes at diagnosis. Urothelial invasion was evident in 21 of 329 T1, 12 of 131 T2, 84 of 388 T3 and 7 of 47 T4 tumors. Three-year overall survival for patients with vs without collecting system invasion by stage was 67% vs 81% for T1, 60% vs 69% for T2, 31% vs 46% for T3 and 29% vs 12% for T4 disease. Patients with urothelial invasion incurred a significant increase in the likelihood of death and were at 1.4 times greater risk of death compared with patients without collecting system invasion.
Our findings suggest that collecting system invasion in RCC cases is associated with specific clinical findings as well as poor prognostic variables and it has a profound impact on prognosis in low stage tumors.
为进一步明确肾细胞癌（RCC）中尿路上皮侵犯对预后的影响，我们对在本机构接受肾切除术治疗的肾癌患者的预后情况进行了研究。
我们回顾了1989年至1999年间接受肾切除术治疗的895例RCC患者的病历。中位随访时间为31个月。根据1997年TNM分期、福尔曼分级和加利福尼亚大学洛杉矶分校综合分期系统分期构建Kaplan-Meier生存曲线，比较有和无集合系统侵犯的患者。进行了单因素和多因素分析。总生存定义为从肾切除到死亡或最后一次随访的时间。
895例患者中，124例（14%）出现集合系统侵犯。有集合系统侵犯的患者在诊断时更可能有症状且伴有转移和/或阳性淋巴结。在329例T1肿瘤中有21例、131例T2肿瘤中有12例、388例T3肿瘤中有84例、47例T4肿瘤中有7例出现尿路上皮侵犯。按分期，有和无集合系统侵犯患者的三年总生存率分别为：T1期67%对81%，T2期60%对69%，T3期31%对46%，T4期29%对12%。有尿路上皮侵犯的患者死亡可能性显著增加，与无集合系统侵犯的患者相比，死亡风险高1.4倍。
我们的研究结果表明，RCC病例中的集合系统侵犯与特定临床发现以及不良预后变量相关，并且对低分期肿瘤的预后有深远影响。
