Fujita Tetsuo, Iwamura Masatsugu, Yanagisawa Nobuyuki, Muramoto Masatoshi, Hirayama Takahiro, Okayasu Isao, Baba Shiro
Department of Urology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.
Urology. 2007 May;69(5):839-42. doi: 10.1016/j.urology.2007.01.035.
To analyze the prognostic impact of the pT3a factors, perirenal fat or adrenal gland involvement, in patients with pT3b renal cell carcinoma (RCC).
A total of 43 patients with pT3b RCC who underwent radical nephrectomy, with complete resection of tumor thrombus, at our institution from March 1972 to September 2005 were enrolled in this study. The presence of pT3a factors was reviewed, and the disease-specific survival was compared according to the reclassification as pT3b only or pT3b with pT3a.
After review by a single pathologist, 23 patients (53.5%) were identified as having pT3b only and 20 patients (46.5%) as having pT3b with pT3a. The mean disease-specific survival time in those with pT3b only was significantly longer at 70.9 +/- 9.1 (SE) months compared with 25.0 +/- 4.4 (SE) months in those with pT3b with pT3a (P = 0.0032). On univariate analyses, the presence of pT3a factors (P = 0.0065), preoperative metastasis (P = 0.0025), surgical specimens positive for lymph node metastasis (P = 0.0183), and spindle cell factor (P = 0.0233) were recognized as predictors of a poor prognosis.
The presence of perirenal fat or adrenal gland involvement in patients with pT3b RCC renders the prognosis significantly worse. Careful postoperative examination should be required, along with reclassification for Stage pT3b with pT3a in RCC.
分析pT3a因素（肾周脂肪或肾上腺受累）对pT3b期肾细胞癌（RCC）患者预后的影响。
本研究纳入了1972年3月至2005年9月期间在我院接受根治性肾切除术且肿瘤血栓完全切除的43例pT3b期RCC患者。回顾pT3a因素的存在情况，并根据重新分类为仅pT3b或伴有pT3a的pT3b来比较疾病特异性生存率。
经单一病理学家复查后，23例患者（53.5%）被确定为仅pT3b，20例患者（46.5%）为伴有pT3a的pT3b。仅pT3b患者的平均疾病特异性生存时间显著更长，为70.9±9.1（SE）个月，而伴有pT3a的pT3b患者为25.0±4.4（SE）个月（P = 0.0032）。单因素分析显示，pT3a因素的存在（P = 0.0065）、术前转移（P = 0.0025）、手术标本淋巴结转移阳性（P = 0.0183）和梭形细胞因素（P = 0.0233）被认为是预后不良的预测因素。
pT3b期RCC患者存在肾周脂肪或肾上腺受累会使预后明显变差。术后应进行仔细检查，并对RCC的pT3b期伴有pT3a进行重新分类。
