Webster W Scott, Lohse Christine M, Thompson R Houston, Dong Haidong, Frigola Xavier, Dicks Demetrius L, Sengupta Shomik, Frank Igor, Leibovich Bradley C, Blute Michael L, Cheville John C, Kwon Eugene D
Department of Urology, Mayo Clinic, Rochester, Minnesota 55905, USA.
Cancer. 2006 Jul 1;107(1):46-53. doi: 10.1002/cncr.21951.
The impact of mononuclear cell infiltration on renal cell carcinoma (RCC) biology has been controversial, previously reported to be associated with either a favorable or unfavorable prognosis. The objective of the current study was to evaluate associations between mononuclear cell infiltration in routinely prepared paraffin-embedded specimens with survival in patients with clear-cell RCC.
A total of 306 patients were identified treated with nephrectomy for clear-cell RCC between 1990 and 1994. A single urologic pathologist, blinded to patient outcome, reviewed the specimens and quantified the extent of mononuclear cell infiltration as absent, focal, moderate, or marked. Cancer-specific survival was estimated using the Kaplan-Meier method. Associations of mononuclear cell infiltration with death from RCC were assessed using Cox proportional hazards regression models.
At last follow-up, 173 of the 306 patients studied had died, including 96 patients who died from RCC. Mononuclear cell infiltration was absent in 165 (54%), focal in 70 (23%), moderate in 53 (17%), and marked in 18 (6%). Univariately, patients with specimens that had mononuclear cell infiltration were over 2 times more likely to die from RCC compared with patients whose specimens exhibited no mononuclear cell infiltration (risk ratio, 2.63; P < .001). After adjusting for the Mayo Clinic SSIGN (stage, size, grade, and necrosis) score, patients with specimens that had mononuclear cell infiltration exhibited a significantly increased likelihood of dying from RCC compared with patients whose specimens had no mononuclear cell infiltration (risk ratio, 1.61; P = .028).
Mononuclear cell infiltration is associated with death from RCC even after multivariate adjustment. Routine documentation of mononuclear cell infiltration is recommended during the pathologic assessment of RCC.
单核细胞浸润对肾细胞癌（RCC）生物学行为的影响一直存在争议，此前报道其与预后良好或不良均相关。本研究的目的是评估常规制备的石蜡包埋标本中的单核细胞浸润与透明细胞RCC患者生存率之间的关联。
共纳入1990年至1994年间接受肾切除术治疗的306例透明细胞RCC患者。由一名对患者预后不知情的泌尿外科病理学家对标本进行复查，并将单核细胞浸润程度量化为无、局灶性、中度或显著。采用Kaplan-Meier法估计癌症特异性生存率。使用Cox比例风险回归模型评估单核细胞浸润与RCC死亡之间的关联。
在最后一次随访时，306例研究患者中有173例死亡，其中96例死于RCC。165例（54%）标本无单核细胞浸润，70例（23%）为局灶性浸润，53例（17%）为中度浸润，18例（6%）为显著浸润。单因素分析显示，标本有单核细胞浸润的患者死于RCC的可能性是标本无单核细胞浸润患者的2倍多（风险比，2.63；P <.001）。在对梅奥诊所SSIGN（分期、大小、分级和坏死）评分进行校正后，标本有单核细胞浸润的患者死于RCC的可能性显著高于标本无单核细胞浸润的患者（风险比，1.61；P = 0.028）。
即使经过多因素校正，单核细胞浸润仍与RCC死亡相关。建议在RCC病理评估过程中常规记录单核细胞浸润情况。
