肾细胞癌中显微镜下静脉侵犯的预后价值：长期随访

Prognostic value of microscopic venous invasion in renal cell carcinoma: long-term follow-up.

作者信息

Lang Hervé, Lindner Véronique, Letourneux Hervé, Martin Mael, Saussine Christian, Jacqmin Didier

机构信息

Department of Urology, Hôpitaux Universitaires de Strasbourg, Service de Chirurgie Urologique, Pavillon Chirurgical A, 1, place de l'hôpital, 67091 Strasbourg Cedex, France.

出版信息

Eur Urol. 2004 Sep;46(3):331-5. doi: 10.1016/j.eururo.2004.03.020.

DOI:10.1016/j.eururo.2004.03.020

PMID:15306103

Abstract

OBJECTIVE

To assess the prognostic value of microscopic venous invasion (MVI) in a long-term follow-up series.

PATIENTS AND METHOD

255 patients had a radical nephrectomy between 1980 and 1990 for pT1 to pT3b N0 M0 renal cell carcinoma. We reviewed the disease free, specific and overall survival after 183 months of median follow-up. Survival analyses using Kaplan-Meier and Log-rank models for univariate comparisons and Cox proportional hazards model for multivariate analyses were performed. The studied variables were: age, size, side, extracapsular invasion, renal vein invasion, local stage, Fuhrman's grade and MVI.

RESULTS

MVI was found in 74 cases (29%). The MVI was strongly correlated to metastases appearance and survival (p < 0.0001). Multivariate analysis of disease free survival showed the following independent variables: size (p < 0.0001) and Fuhrman's grade (p < 0.0001). For cancer specific survival, the analysis found size (p < 0.0001), age (p = 0.0005), Fuhrman's grade (p = 0.0035) and MVI (p = 0.016) with a relative risk of cancer related death of 2.16. Independent prognostic factors of overall survival were age (p < 0.0001), size (p < 0.0001), MVI (p = 0.015) and Fuhrman's grade (p = 0.045). The relative risk of cancer related death for MVI is 1.82.

CONCLUSION

It seems that MVI is an independent prognostic factor of survival for patients with pT1 to pT3b N0 M0 renal cell carcinoma.

摘要

目的

评估显微镜下静脉侵犯（MVI）在长期随访系列中的预后价值。

患者与方法

255例患者于1980年至1990年间因pT1至pT3b N0 M0肾细胞癌接受了根治性肾切除术。我们回顾了中位随访183个月后的无病生存期、特异性生存期和总生存期。采用Kaplan-Meier法和Log-rank模型进行单因素比较的生存分析，并采用Cox比例风险模型进行多因素分析。研究变量包括：年龄、肿瘤大小、肿瘤位置、包膜外侵犯、肾静脉侵犯、局部分期、Fuhrman分级和MVI。

结果

74例（29%）发现有MVI。MVI与转移的出现和生存期密切相关（p<0.0001）。无病生存期的多因素分析显示以下独立变量：肿瘤大小（p<0.0001）和Fuhrman分级（p<0.0001）。对于癌症特异性生存期，分析发现肿瘤大小（p<0.0001）、年龄（p = 0.0005）、Fuhrman分级（p = 0.0035）和MVI（p = 0.016），癌症相关死亡的相对风险为2.16。总生存期的独立预后因素为年龄（p<0.0001）、肿瘤大小（p<0.0001）、MVI（p = 0.015）和Fuhrman分级（p = 0.045）。MVI导致癌症相关死亡的相对风险为1.82。