Karakiewicz Pierre I, Trinh Quoc-Dien, Bhojani Naeem, Bensalah Karim, Salomon Laurent, de la Taille Alexandre, Tostain Jacques, Cindolo Luca, Altieri Vincenzo, Ficarra Vincenzo, Schips Luigi, Zigeuner Richard, Mulders Peter F A, Valeri Antoine, Descotes Jean-Luc, Mejean Arnaud, Patard Jean-Jacques
Cancer Prognostics and Health Outcome Unit, University of Montreal Health Center, Montreal, Quebec, Canada, and Department of Urology, Rennes University Hospital, France.
Eur Urol. 2007 Jun;51(6):1616-24. doi: 10.1016/j.eururo.2006.12.015. Epub 2006 Dec 14.
Outcome of patients with exclusive renal cell carcinoma (RCC) nodal metastases without distant metastases is not extensively described. We explored the ability of standard risk factors such as tumour size, Fuhrman grade, histologic subtype and symptom classification to predict renal cell carcinoma-specific survival (RCC-SS).
Analyses targeted 171 patients with RCC nodal metastases and absence of distant metastases. Univariable, multivariable, and predictive accuracy analyses addressed RCC-SS with the intent of identifying independent and most informative predictors of RCC-SS in this cohort of patients.
Median RCC-SS was 2.3 yr. Symptom classification (61.3%, p<0.001) demonstrated the highest univariable accuracy. In multivariable analyses, symptom classification contributed the most to the combined predictive accuracy of all variables (+4.2%, p<0.001), followed by Fuhrman grade (+2.3%) and histologic subtype (+1.0%).
Renal cell carcinoma-specific survival of patients with exclusive nodal metastases may show important variability. In presence of systemic symptoms, survival is extremely poor. Substantially better survival may be expected in patients with local or no symptoms. This observation has important implications when adjuvant therapies are considered.
对于仅发生肾细胞癌（RCC）淋巴结转移而无远处转移的患者，其预后情况尚未得到广泛描述。我们探讨了肿瘤大小、富尔曼分级、组织学亚型和症状分类等标准危险因素预测肾细胞癌特异性生存（RCC-SS）的能力。
分析针对171例发生RCC淋巴结转移且无远处转移的患者。单变量、多变量和预测准确性分析均针对RCC-SS，旨在确定该队列患者中RCC-SS的独立且最具信息量的预测因素。
RCC-SS的中位数为2.3年。症状分类（61.3%，p<0.001）显示出最高的单变量准确性。在多变量分析中，症状分类对所有变量的综合预测准确性贡献最大（+4.2%，p<0.001），其次是富尔曼分级（+2.3%）和组织学亚型（+1.0%）。
仅发生淋巴结转移的患者的肾细胞癌特异性生存可能存在重要差异。出现全身症状时，生存率极低。局部或无症状患者的生存率可能会显著提高。在考虑辅助治疗时，这一观察结果具有重要意义。
