Thompson R Houston, Cheville John C, Lohse Christine M, Webster W Scott, Zincke Horst, Kwon Eugene D, Frank Igor, Blute Michael L, Leibovich Bradley C
Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, Minnesota 55905, USA.
Cancer. 2005 Jul 1;104(1):53-60. doi: 10.1002/cncr.21125.
The significance of adrenal invasion and tumor thrombus in renal cell carcinoma (RCC) has been debated recently. The authors evaluated the associations of direct adrenal invasion, perinephric fat invasion, and tumor thrombus level with outcome to determine whether reclassification would improve the prognostic accuracy of the current primary tumor classification.
The authors studied 697 patients treated with nephrectomy for pT3 and pT4 RCC between 1970 and 2000. Associations with outcome were evaluated using Cox proportional hazards regression and prognostic accuracy was measured using the c index.
Among patients with pT3 RCC, direct adrenal invasion was significantly associated with death from RCC (risk ratio, 2.11; P = 0.004). No significant difference in survival was found between patients with pT4 RCC and pT3 tumors with direct adrenal invasion (P = 0.490). Among patients with pT3b RCC, those with level I-III tumor thrombus were significantly more likely to die of RCC compared with patients harboring level 0 tumor thrombus (risk ratio, 1.62; P < 0.001). In addition, patients with fat invasion were more likely to die of RCC compared with pT3 patients without fat invasion (risk ratio, 1.87; P < 0.001). Therefore, patients with pT3 RCC were reclassified into 4 prognostic groups, and this reclassification significantly improved prediction of death from RCC compared with the current classification (c indices of 0.61 vs. 0.55, respectively).
Direct adrenal invasion from RCC should be reclassified as pT4. In addition, the proposed reclassification for patients with pT3 RCC improved prognostic accuracy.
肾上腺侵犯和肿瘤血栓在肾细胞癌（RCC）中的意义近来一直存在争议。作者评估了直接肾上腺侵犯、肾周脂肪侵犯和肿瘤血栓水平与预后的相关性，以确定重新分类是否会提高当前原发性肿瘤分类的预后准确性。
作者研究了1970年至2000年间接受肾切除术治疗的697例pT3和pT4期RCC患者。使用Cox比例风险回归评估与预后的相关性，并使用c指数测量预后准确性。
在pT3期RCC患者中，直接肾上腺侵犯与RCC死亡显著相关（风险比，2.11；P = 0.004）。pT4期RCC患者与有直接肾上腺侵犯的pT3期肿瘤患者之间的生存率无显著差异（P = 0.490）。在pT3b期RCC患者中，与肿瘤血栓为0级的患者相比，肿瘤血栓为I - III级的患者死于RCC的可能性显著更高（风险比，1.62；P < 0.001）。此外，与无脂肪侵犯的pT3期患者相比，有脂肪侵犯的患者死于RCC的可能性更大（风险比，1.87；P < 0.001）。因此，将pT3期RCC患者重新分类为4个预后组，与当前分类相比，这种重新分类显著改善了RCC死亡的预测（c指数分别为0.61和0.55）。
RCC的直接肾上腺侵犯应重新分类为pT4。此外，提议的pT3期RCC患者重新分类提高了预后准确性。
