Margulis Vitaly, Sánchez-Ortiz Ricardo F, Tamboli Pheroze, Cohen Daniel D, Swanson David A, Wood Christopher G
Department of Urology, University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
Cancer. 2007 May 15;109(10):2025-30. doi: 10.1002/cncr.22629.
Historically, patients with nonmetastatic renal cell carcinoma (RCC) involving adjacent organs have been considered inoperable and incurable. The oncologic efficacy of an aggressive surgical approach was evaluated in a selected subpopulation of RCC patients. Further, an attempt was made to define the clinical and pathologic characteristics predictive of surgical failure.
With Institutional Review Board approval, the institutional nephrectomy database of 3470 patients treated at MD Anderson Cancer Center from 1990 to 2006 was searched for RCC patients treated with radical nephrectomy and resection of at least 1 adjacent organ thought to be directly involved by RCC. Patients with nonmetastatic RCC and a minimum follow-up of 6 months were included in the analysis.
In all, 30 patients with clinical T4NxM0 RCC and median follow-up of 32.3 months (range, 8.5-140.1) met the study inclusion criteria and comprise the dataset for the analysis. On pathologic evaluation 60% of patients were clinically overstaged, as only 12 (40%) of 30 patients demonstrated direct invasion into adjacent organs resected. None of the clinical tumor characteristics predicted a finding of pathologic T4 RCC. Nodal involvement and pathologic T stage were significant independent predictors of disease recurrence (hazard ratio [HR] 3.726, P = .043, and HR 2.414, P = .045, respectively) and cancer-specific survival (HR 17.145, P = .002, and HR 3.791, P = .024, respectively). Disease recurred in 11 of 18 (61.1%) of <pT4 patients and in 10 of 12 (83.3%) of pT4 patients at a median 13.3 and 2.3 months, respectively; 13 (73.3%) <pT4 patients and 5 (41.7%) pT4 patients were alive at the time of analysis.
True pathologic involvement of adjacent organs by RCC cannot be predicted from pre- or intraoperative parameters. A significant proportion of patients clinically suspected of having T4 RCC are downstaged, and benefit from aggressive surgical resection with en bloc removal of involved organs.
在历史上，患有累及相邻器官的非转移性肾细胞癌（RCC）的患者一直被认为无法手术切除且无法治愈。对一部分选定的RCC患者评估了积极手术方法的肿瘤学疗效。此外，还试图确定预测手术失败的临床和病理特征。
经机构审查委员会批准，检索了1990年至2006年在MD安德森癌症中心接受治疗的3470例患者的机构肾切除术数据库，以查找接受根治性肾切除术并切除至少1个被认为直接受RCC累及的相邻器官的RCC患者。分析纳入了非转移性RCC且随访至少6个月的患者。
共有30例临床分期为T4NxM0的RCC患者，中位随访时间为32.3个月（范围8.5 - 140.1个月），符合研究纳入标准，构成分析数据集。病理评估显示，60%的患者临床分期过高，因为30例患者中只有12例（40%）表现出直接侵犯所切除的相邻器官。没有任何临床肿瘤特征能够预测病理T4期RCC的发现。淋巴结受累和病理T分期是疾病复发（风险比[HR]分别为3.726，P = 0.043，以及HR 2.414，P = 0.045）和癌症特异性生存（HR分别为17.145，P = 0.002，以及HR 3.791，P = 0.024）的显著独立预测因素。<pT4患者中18例有11例（61.1%）复发，pT4患者中12例有10例（83.3%）复发，中位复发时间分别为13.3个月和2.3个月；分析时，<pT4患者中有13例（73.3%）存活，pT4患者中有5例（41.7%）存活。
无法根据术前或术中参数预测RCC对相邻器官的真正病理累及情况。很大一部分临床怀疑为T4期RCC患者的分期被下调，并且通过积极手术切除并整块切除受累器官而获益。
