Giménez Bachs José Miguel, Donate Moreno Ma José, Salinas Sánchez Antonio S, Pastor Navarro Héctor, Carrión López Pedro, Pastor Guzmán José María, Polo Ruíz Lorenzo, Martínez Martín Mariano, Ruíz Mondéjar Rafael, Virseda Rodríguez Julio A
Servicio de Urología, Complejo Hospitalario Universitario de Albacete, Albacete, España.
Arch Esp Urol. 2007 Dec;60(10):1.167-1.174. doi: 10.4321/s0004-06142007001000004.
To analyze the survival rate in a series of patients with the diagnosis of renal cell carcinoma over a 19 year period based on prognostic factors usually employed in clinical practice.
Retrospective study of 259 consecutive patients with the diagnosis of renal cell carcinoma undergoing surgery in our department between 1988 and 2006. From clinical, pathological, and follow-up data we performed a survival study comparing the impact of usual prognostic factors: stage, tumor size, nuclear grade, etc.
264 surgical procedures were performed in 259 patients, with a mean age of 6 1.91 yr. The most frequent way of diagnosis was incidental finding (52.12% of the cases); radical nephrectomy was performed in 72.97% of the cases in comparison with 26.25% partial nephrectomies. Clear cell carcinoma was the most frequent histological diagnosis (69.88%). Patients with clear cell carcinoma, symptomatic tumors, bigger size, and greater Fuhrman nuclear grade presented worse survivals, mainly in tumors with stage >pT3a. The presence of involved lymph nodes or distant metastases is associated with a much lower cancer-specific survival. Global five-year cancer-specific survival was over 80%.
The classical prognostic factors used to predict survival in renal cancer are still useful, mainly pathological stage pT. We observed a better survival in comparison with older series, but this kind of tumors continue generating important morbidity-mortality.
基于临床实践中常用的预后因素,分析19年间一系列诊断为肾细胞癌患者的生存率。
对1988年至2006年间在我科接受手术的259例连续诊断为肾细胞癌的患者进行回顾性研究。根据临床、病理和随访数据,我们进行了一项生存研究,比较了常见预后因素(分期、肿瘤大小、核分级等)的影响。
259例患者共进行了264例手术,平均年龄61.91岁。最常见的诊断方式是偶然发现(占病例的52.12%);72.97%的病例进行了根治性肾切除术,而部分肾切除术占26.25%。透明细胞癌是最常见的组织学诊断(69.88%)。透明细胞癌、有症状的肿瘤、较大尺寸以及较高Fuhrman核分级的患者生存率较差,主要是在分期>pT3a的肿瘤中。存在受累淋巴结或远处转移与癌症特异性生存率低得多相关。总体五年癌症特异性生存率超过80%。
用于预测肾癌生存的经典预后因素仍然有用,主要是病理分期pT。与较旧系列相比,我们观察到生存率有所提高,但这类肿瘤仍继续产生重要的发病率和死亡率。