Bruno J James, Snyder Mark E, Motzer Robert J, Russo Paul
Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
BJU Int. 2006 May;97(5):933-8. doi: 10.1111/j.1464-410X.2006.06076.x.
To analyse the survival benefit of resecting local recurrence (LR) of renal cell carcinoma (RCC) in the presence and absence of concomitant metastasis.
From 1989 to 2004 we identified 34 patients with LRs (2.9%) of the 1165 radical nephrectomies performed for T1-4N0M0 disease. Of these, 18 (53%) had no evidence of metastasis (isolated LR incidence, 1.5%) and 16 (47%) had synchronous metastasis. Of the 18 patients with no metastasis, 11 had complete surgical resection (group I) and seven had nonsurgical therapy (group II). Of the 16 patients with synchronous metastasis, five had surgery (group III) and 11 did not (group IV). Survival was projected using the Kaplan-Meier method and log-rank test for each group.
Eight of the 34 patients (24%) were symptomatic. The T stage of the initial nephrectomy was T1a in two cases, T1b in six, T2 in five, T3a in six, T3b in eight, T4 in six and unknown in one; 22 patients (65%) had clear cell histology. There were no significant differences in median time to LR or the LR size among the groups. The median (range) follow-up was 16.9 (0.5-103.6) months. Of the 11 patients in group I, three remain with no evidence of disease, three are alive with metastatic disease, and five died from disease. By contrast, 21 of the 23 patients (91%) in groups II, III and IV died from disease. The overall estimated 1-, 3- and 5-year survivals were 63%, 31% and 18%. The median survival time was 71.4 months for group I, 9.9 for II, 16.3 for III, and 11.8 for IV (P < 0.01) with a 5-year survival of 62% for group I and 0% for groups II, III, and IV.
LR after radical nephrectomy is rare (2.9%) and has a poor prognosis. The presence of synchronous metastasis and nonoperative therapy are related to these low survival rates. However, if there is no metastatic disease, complete surgical resection of LRs is associated with improved survival.
分析在伴有或不伴有同步转移的情况下，肾细胞癌（RCC）局部复发（LR）切除后的生存获益情况。
1989年至2004年期间，我们在为T1 - 4N0M0疾病行根治性肾切除术的1165例患者中，确定了34例发生LR的患者（2.9%）。其中，18例（53%）无转移证据（孤立性LR发生率为1.5%），16例（47%）有同步转移。在18例无转移的患者中，11例行完整手术切除（I组），7例接受非手术治疗（II组）。在16例有同步转移的患者中，5例行手术治疗（III组），11例未行手术治疗（IV组）。采用Kaplan - Meier法和对数秩检验对每组患者的生存情况进行预测。
34例患者中有8例（24%）出现症状。初次肾切除术的T分期为T1a 2例、T1b 6例、T2 5例、T3a 6例、T3b 8例、T4 6例，1例未知；22例患者（65%）为透明细胞组织学类型。各组间至LR的中位时间或LR大小无显著差异。中位（范围）随访时间为16.9（0.5 - 103.6）个月。I组的11例患者中，3例无疾病证据，3例有转移灶存活，5例死于疾病。相比之下，II、III和IV组的23例患者中有21例（91%）死于疾病。总体估计的1年、3年和5年生存率分别为63%、31%和18%。I组的中位生存时间为71.4个月，II组为9.9个月，III组为16.3个月，IV组为11.8个月（P < 0.01），I组的5年生存率为62%，II、III和IV组为0%。
根治性肾切除术后LR罕见（2.9%），预后较差。同步转移的存在和非手术治疗与这些低生存率相关。然而，如果没有转移性疾病，LR的完整手术切除与生存改善相关。
