Madbouly Khaled, Al-Qahtani Saeed M, Ghazwani Yahia, Al-Shaibani Saeed, Mansi Mostafa K
Department of Surgery, Division of Urology, King Fahad National Guard Hospital, Riyadh, Saudi Arabia.
Urology. 2007 Apr;69(4):670-4. doi: 10.1016/j.urology.2007.01.012.
To evaluate the role of microvascular tumor invasion (MVI) in clinical behavior and prognosis of low-stage renal cell carcinoma.
We retrospectively reviewed the records of patients who had undergone radical nephrectomy from 1990 to 2004 for clinically confined kidney tumors (Stage T1-T2N0M0) with a minimal follow-up period of 1 year. The pathology slides were reviewed regarding tumor diameter, pathologic tumor stage, histologic cell type, nuclear grade, macroscopic or MVI, perirenal fat invasion, and neoplastic lymph node involvement.
A total of 48 patients, 22 men and 26 women (mean +/- SD age 50.73 +/- 13.03 years, range 20-80) were included in the study. The patients were followed up for a mean +/- SD of 37.65 +/- 18.19 months (range 12-60). MVI was encountered in 8 patients (16.7%); 50% developed treatment failure in the form of distant metastases. Of the 40 patients without MVI, only 2 (5%) had treatment failure. MVI had a statistically significant association with sex (P = 0.017) and stage (P = 0.039). On comparing treatment failure with different patient and histologic parameters, a statistically significant association was noted with sex (P = 0.006) and MVI (P = 0.005). The 5-year disease-free survival rate was estimated at 45% and 90% when MVI was and was not present. Only MVI showed an independent statistically significant impact (P = 0.007) on multivariate analysis considering the impact of MVI, stage, grade, cell type, perirenal fat invasion, tumor size, and patient age on disease-free survival.
The results of our study have shown that MVI is an independent and relevant prognostic parameter for clinically low-stage renal cell carcinoma.
评估微血管肿瘤浸润（MVI）在低分期肾细胞癌临床行为及预后中的作用。
我们回顾性分析了1990年至2004年因临床局限型肾肿瘤（T1 - T2N0M0期）接受根治性肾切除术患者的记录，最短随访期为1年。复查病理切片，观察肿瘤直径、病理肿瘤分期、组织学细胞类型、核分级、大体或微血管浸润、肾周脂肪浸润及肿瘤性淋巴结受累情况。
本研究共纳入48例患者，其中男性22例，女性26例（平均年龄±标准差为50.73±13.03岁，范围20 - 80岁）。患者平均随访时间±标准差为37.65±18.19个月（范围12 - 60个月）。8例患者（16.7%）出现微血管浸润；其中50%以远处转移形式出现治疗失败。在40例无微血管浸润的患者中，仅有2例（5%）出现治疗失败。微血管浸润与性别（P = 0.017）和分期（P = 0.039）存在统计学显著关联。比较不同患者及组织学参数与治疗失败情况时，发现与性别（P = 0.006）和微血管浸润（P = 0.005）存在统计学显著关联。存在和不存在微血管浸润时，5年无病生存率分别估计为45%和90%。在多因素分析中，考虑微血管浸润、分期、分级、细胞类型、肾周脂肪浸润、肿瘤大小及患者年龄对无病生存的影响时，仅微血管浸润显示出独立的统计学显著影响（P = 0.007）。
我们的研究结果表明，微血管浸润是临床低分期肾细胞癌的一个独立且相关的预后参数。
