Krejci Kent G, Blute Michael L, Cheville John C, Sebo Thomas J, Lohse Christine M, Zincke Horst
Department of Urology, Mayo Clinic, Rochester, Minnesota 55905, USA.
Urology. 2003 Oct;62(4):641-6. doi: 10.1016/s0090-4295(03)00489-8.
To determine the clinicopathologic features associated with outcome in patients with sporadic renal cell carcinoma (RCC) treated with nephron-sparing surgery.
We studied 344 patients treated with nephron-sparing surgery between 1970 and 2000. The pathologic features of the tumors were reviewed by two urologic pathologists who recorded the histologic subtype, 2003 TNM stage, tumor size, and grade. Cancer-specific survival (CSS) was estimated using the Kaplan-Meier method, and log-rank tests were used to compare the outcome by histologic subtype. Univariate Cox proportional hazards models were fit to assess the associations between the clinicopathologic features and death from RCC, distant metastases, and local recurrence.
The CSS rate at 5 and 10 years for patients with clear cell RCC was 94.4% and 91.5%, respectively. In contrast, the CSS rate at 5 and 10 years for patients with papillary or chromophobe RCC was 99.0%, because only 1 patient died of papillary RCC and no patient died of chromophobe RCC (P = 0.029). Among the patients with localized clear cell RCC, tumor stage and grade were significantly associated with death from RCC and metastases. Grade was significantly associated with local recurrence for clear cell RCC, but not for papillary RCC.
In our series of patients with RCC treated with nephron-sparing surgery, patients with clear cell RCC had a significantly worse CSS than did patients with papillary and chromophobe RCC. Tumor stage and grade were associated with outcome among patients with localized clear cell RCC. These findings are similar to the results for patients with localized clear cell RCC treated with radical nephrectomy.
确定接受保留肾单位手术治疗的散发性肾细胞癌（RCC）患者的临床病理特征与预后的相关性。
我们研究了1970年至2000年间接受保留肾单位手术治疗的344例患者。两名泌尿外科病理学家对肿瘤的病理特征进行了回顾，记录了组织学亚型、2003版TNM分期、肿瘤大小和分级。采用Kaplan-Meier法估计癌症特异性生存率（CSS），并使用对数秩检验比较不同组织学亚型的预后。采用单因素Cox比例风险模型评估临床病理特征与RCC死亡、远处转移和局部复发之间的关联。
透明细胞RCC患者5年和10年的CSS率分别为94.4%和91.5%。相比之下，乳头状或嫌色细胞RCC患者5年和10年的CSS率为99.0%，因为只有1例乳头状RCC患者死亡，没有嫌色细胞RCC患者死亡（P = 0.029）。在局限性透明细胞RCC患者中，肿瘤分期和分级与RCC死亡及转移显著相关。分级与透明细胞RCC的局部复发显著相关，但与乳头状RCC无关。
在我们这组接受保留肾单位手术治疗的RCC患者中，透明细胞RCC患者的CSS明显低于乳头状和嫌色细胞RCC患者。肿瘤分期和分级与局限性透明细胞RCC患者的预后相关。这些发现与接受根治性肾切除术的局限性透明细胞RCC患者的结果相似。
