Lee Sang Eun, Byun Seok-Soo, Oh Jin Kyu, Lee Sang Chul, Chang In Ho, Choe Gheeyoung, Hong Sung Kyu
Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea.
J Urol. 2006 Oct;176(4 Pt 1):1332-7; discussion 1337-8. doi: 10.1016/j.juro.2006.06.021.
We investigated the prognostic significance of macroscopic tumor necrosis in renal cell carcinoma.
We retrospectively analyzed the records of 485 patients who underwent surgical treatment for organ confined or metastatic renal cell carcinoma. The presence or absence of tumor necrosis was evaluated based on macroscopic description of the tumor, and tumors were considered necrotic only if they exhibited more than 10% macroscopic necrosis.
Macroscopic tumor necrosis was identified in 27% of total patients. Patients with macroscopic necrotic renal cell carcinoma were more likely to have larger tumor, metastatic disease, higher local stage and higher tumor grade (all p < 0.001). Pathological features of microvascular invasion (p = 0.026) and sarcomatoid differentiation (p = 0.002) along with several laboratory findings were also observed to be associated with macroscopic tumor necrosis. Among the total subjects those without macroscopic tumor necrosis had significantly higher progression-free (p < 0.0001) and disease specific survival (p < 0.0001). When survival analysis was limited to nonmetastatic tumors only, the same logic applied, which was not the case for the patients with metastatic disease (p > 0.05). Among the different histological subtypes of renal cell carcinoma, macroscopic tumor necrosis was observed to have a significant impact only for the clear cell subtype. In patients with nonmetastatic RCC multivariate analysis revealed that macroscopic tumor necrosis (p = 0.004) was an independent prognostic predictor of disease specific survival along with pathological T stage, tumor grade and tumor size.
Our results suggest that macroscopic tumor necrosis may be a reliable prognostic indicator for nonmetastatic clear cell renal cell carcinoma which should routinely be examined for during pathological analysis.
我们研究了肾细胞癌中宏观肿瘤坏死的预后意义。
我们回顾性分析了485例接受手术治疗的局限性或转移性肾细胞癌患者的记录。根据肿瘤的宏观描述评估肿瘤坏死的有无，仅当肿瘤出现超过10%的宏观坏死时才被视为坏死。
在所有患者中，27%发现有宏观肿瘤坏死。有宏观坏死的肾细胞癌患者更有可能有更大的肿瘤、转移性疾病、更高的局部分期和更高的肿瘤分级（所有p<0.001）。微血管侵犯（p=0.026）和肉瘤样分化（p=0.002）的病理特征以及一些实验室检查结果也被观察到与宏观肿瘤坏死有关。在所有受试者中，没有宏观肿瘤坏死的患者无进展生存期（p<0.0001）和疾病特异性生存期显著更高（p<0.0001）。当生存分析仅限于非转移性肿瘤时，同样的逻辑适用，而转移性疾病患者则不然（p>0.05）。在肾细胞癌的不同组织学亚型中，宏观肿瘤坏死仅对透明细胞亚型有显著影响。在非转移性肾细胞癌患者中，多变量分析显示宏观肿瘤坏死（p=0.004）是疾病特异性生存期的独立预后预测指标，与病理T分期、肿瘤分级和肿瘤大小相关。
我们的结果表明，宏观肿瘤坏死可能是非转移性透明细胞肾细胞癌的可靠预后指标，在病理分析中应常规检查。
