Antonelli Alessandro, Cozzoli Alberto, Zani Danilo, Zanotelli Tiziano, Nicolai Maria, Cunico Sergio Cosciani, Simeone Claudio
Department of Urology, University of Brescia, Brescia, Italy.
BJU Int. 2007 Feb;99(2):296-300. doi: 10.1111/j.1464-410x.2006.06616.x.
To define a follow-up protocol based on the University of California Los Angeles Integrated Staging System (UISS) for patients undergoing surgery for N0M0 renal cell carcinoma (RCC).
The clinical records of patients treated with radical surgery for N0/NXM0 RCC and monitored through periodic follow-up studies (> or =24 months in disease-free patients) were reviewed retrospectively from 1399 patients surgically treated for renal neoplasms between 1983 and 2005. Each case was assigned a UISS risk category; recurrence features, time and site were recorded. In particular, recurrence sites were categorized into local, renal (ipsilateral or contralateral) and distant (single-site or disseminated).
The records were reviewed of 814 patients with a mean follow-up of 75.6 months. UISS risk categories were distributed as follows: high-risk (HR) 17.2%, intermediate-risk (IR) 51.6% and low-risk (LR) 31.2%. Disease-free survival rates at 5 years were 63.9%, 88.3% and 96.5% (log-rank test P < 0.001), respectively. The disease recurred in 193 patients (23.7%), at distant sites (73.0% of recurrences), locally (11.9%), in the contralateral kidney (10.9%) and in the ipsilateral kidney (4.1%). There was a significant correlation between UISS category and risk of distant or local (both P < 0.001) recurrences, whereas there was no correlation of recurrences in the operated kidney (P = 0.372) or contralateral kidney (P = 0.898).
The prognostic accuracy and applicability of the UISS for distant and local recurrences is confirmed, whereas renal relapses have an independent course. A follow-up scheme tailored to the recurrence patterns observed in each UISS risk group is recommended.
为接受手术治疗的N0M0肾细胞癌（RCC）患者制定基于加利福尼亚大学洛杉矶分校综合分期系统（UISS）的随访方案。
回顾性分析1983年至2005年间1399例接受肾肿瘤手术治疗患者的临床记录，这些患者接受了N0/NXM0 RCC根治性手术，并通过定期随访研究进行监测（无病患者随访时间≥24个月）。为每个病例指定一个UISS风险类别；记录复发特征、时间和部位。特别是，复发部位分为局部、肾脏（同侧或对侧）和远处（单部位或播散性）。
对814例患者的记录进行了回顾，平均随访时间为75.6个月。UISS风险类别分布如下：高危（HR）17.2%，中危（IR）51.6%，低危（LR）31.2%。5年无病生存率分别为63.9%、88.3%和96.5%（对数秩检验P<0.001）。193例患者（23.7%）出现疾病复发，复发部位为远处（占复发的73.0%）、局部（11.9%）、对侧肾脏（10.9%）和同侧肾脏（4.1%）。UISS类别与远处或局部复发风险之间存在显著相关性（两者P<0.001），而手术侧肾脏（P = 0.372）或对侧肾脏（P = 0.898）的复发无相关性。
UISS对远处和局部复发的预后准确性和适用性得到证实，而肾脏复发有独立的病程。建议根据每个UISS风险组观察到的复发模式制定随访方案。
