Terrone C, Gontero P, Volpe A, Porpiglia F, Bollito E, Zattoni F, Frea B, Tizzani A, Fontana D, Scarpa R M, Rossetti S Rocca
Department of Urology, Azienda Ospedaliera Maggiore della Carità, Novara, Italy.
J Urol. 2008 Jul;180(1):72-8. doi: 10.1016/j.juro.2008.03.029. Epub 2008 May 15.
The prognostic accuracy of the current TNM 2002 staging system for locally advanced renal cell carcinoma has been questioned. To contribute to the development of a more accurate classification for this stage of disease we assessed the correlation between patterns of invasion in the pT3 category and outcomes in a large multi-institutional series.
Pathological data and clinical followup on 513 pT3 renal cell carcinoma cases treated with radical nephrectomy between 1983 and 2005 at 3 Italian academic centers were retrospectively reviewed. Cause specific survival rates were calculated with the Kaplan-Meier method and multivariate analysis was performed using the Cox proportional hazards regression model.
Estimated overall 5-year cause specific survival was 50.1% at a median followup of 61.5 months in survivors. The current TNM classification was not a significant outcome prognosticator. Patients with a tumor invading only the perirenal or sinus fat were at lowest risk for death from the disease. Patients at intermediate risk had tumors with invasion of the venous system alone. Simultaneous perirenal fat and sinus fat invasion or perirenal fat and vascular invasion as well as adrenal gland involvement characterized high risk tumors. Low risk tumors could be further divided into 2 groups with different outcomes based on a size cutoff of 7 cm. Our classification was a significant predictor of survival on multivariate analysis as well as M stage, N stage, Fuhrman grade and tumor size.
We confirm that the prognostic usefulness of the current 2002 TNM system for pT3 renal cell carcinoma is limited. We have identified 4 groups of tumors with distinct patterns of invasion and significantly different survival probabilities in this category. Large prospective series are needed to validate these findings.
目前的2002年TNM分期系统对局部进展期肾细胞癌的预后准确性受到质疑。为了有助于开发针对该疾病阶段更准确的分类方法，我们在一个大型多机构系列研究中评估了pT3类别中的侵袭模式与预后之间的相关性。
回顾性分析了1983年至2005年期间在3个意大利学术中心接受根治性肾切除术的513例pT3肾细胞癌病例的病理数据和临床随访情况。采用Kaplan-Meier方法计算特定病因生存率，并使用Cox比例风险回归模型进行多变量分析。
在幸存者中，中位随访61.5个月时，估计总体5年特定病因生存率为50.1%。目前的TNM分类不是一个显著的预后指标。仅侵犯肾周或肾窦脂肪的肿瘤患者死于该疾病的风险最低。中度风险患者的肿瘤仅侵犯静脉系统。同时侵犯肾周脂肪和肾窦脂肪或肾周脂肪和血管以及肾上腺受累是高风险肿瘤的特征。低风险肿瘤可根据7 cm的大小临界值进一步分为两组，其预后不同。在多变量分析以及M分期、N分期、Fuhrman分级和肿瘤大小方面，我们的分类是生存的显著预测指标。
我们证实，目前的2002年TNM系统对pT3肾细胞癌的预后价值有限。我们在该类别中确定了4组具有不同侵袭模式和显著不同生存概率的肿瘤。需要大型前瞻性系列研究来验证这些发现。
