Yoo Changhee, Song Cheryn, Hong Jun Hyuk, Kim Choung-Soo, Ahn Hanjong
Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
J Urol. 2008 Aug;180(2):486-91; discussion 491. doi: 10.1016/j.juro.2008.04.034. Epub 2008 Jun 11.
It is controversial that perinephric fat infiltration has an impact on survival in patients with renal cell carcinoma. Therefore, we evaluated the influence of perinephric fat infiltration and tumor size on patient survival.
We retrospectively reviewed the medical records of 783 and 77 patients with pT1-2 (cN0M0) and pT3a (cN0M0) renal cell carcinoma, respectively. Sporadic unilocular noncystic renal cell carcinoma was included. Univariate and multivariate analyses of prognostic factors, including perinephric fat infiltration, on cancer specific and disease-free survival were performed. Median followup was 56.0 months after surgery.
Patients with pT1-2 and pT3a tumors had a 5-year cancer specific survival rate of 96.1% and 84.9%, and a 5-year disease-free survival rate of 93.4% and 74.7%, respectively (each p <0.01). Age, tumor size and Fuhrman nuclear grade were independent prognostic factors for cancer specific and disease-free survival, whereas perinephric fat infiltration was significant only for disease-free survival. However, perinephric fat infiltration had a significant effect on cancer specific survival in patients with pT3a tumors more than 7 cm (p = 0.001). In contrast, patients with pT3a tumors 7 cm or less had cancer specific and disease-free survival similar to that of patients with pT2 tumors. Recurrence of pT3a tumors greater than 7 cm was observed in 44% of patients but in only 14.6% of those with pT3a tumors 7 cm or less (p = 0.029). In contrast to the recurrence of tumors 7 cm or less, recurrence of pT3a tumors more than 7 cm usually developed at multiple sites with a large tumor burden and it progressed rapidly. Consequently 85% of patients with recurrence of pT3a tumors larger than 7 cm died of renal cell carcinoma compared with 33% of those with recurrence of pT3a tumors 7 cm or less (p = 0.001).
In pT3a renal cell carcinoma tumor size was the strongest prognostic factor of disease-free and cancer specific survival. Perinephric fat infiltration was an independent prognostic factor for disease-free survival but not for cancer specific survival due to the less aggressive behavior of small (7 cm or less) pT3a tumors after recurrence. Tumor size and perinephric fat infiltration should be included in T3a renal cell carcinoma staging.
肾周脂肪浸润对肾细胞癌患者生存率的影响存在争议。因此，我们评估了肾周脂肪浸润和肿瘤大小对患者生存率的影响。
我们分别回顾性分析了783例pT1-2（cN0M0）和77例pT3a（cN0M0）肾细胞癌患者的病历。纳入散发性单房非囊性肾细胞癌。对包括肾周脂肪浸润在内的预后因素进行单因素和多因素分析，以评估其对癌症特异性生存率和无病生存率的影响。术后中位随访时间为56.0个月。
pT1-2和pT3a肿瘤患者的5年癌症特异性生存率分别为96.1%和84.9%，5年无病生存率分别为93.4%和74.7%（均p<0.01）。年龄、肿瘤大小和Fuhrman核分级是癌症特异性生存率和无病生存率的独立预后因素，而肾周脂肪浸润仅对无病生存率有显著影响。然而，肾周脂肪浸润对肿瘤直径大于7 cm的pT3a肿瘤患者的癌症特异性生存率有显著影响（p = 0.001）。相比之下，肿瘤直径7 cm及以下的pT3a肿瘤患者的癌症特异性生存率和无病生存率与pT2肿瘤患者相似。肿瘤直径大于7 cm的pT3a肿瘤患者的复发率为44%，而肿瘤直径7 cm及以下的pT3a肿瘤患者的复发率仅为14.6%（p = 0.029）。与肿瘤直径7 cm及以下的复发情况不同，肿瘤直径大于7 cm的pT3a肿瘤复发通常发生在多个部位，肿瘤负荷大且进展迅速。因此，肿瘤直径大于7 cm的pT3a肿瘤复发患者中85%死于肾细胞癌，而肿瘤直径7 cm及以下的pT3a肿瘤复发患者中这一比例为33%（p = 0.00）。
在pT3a肾细胞癌中，肿瘤大小是无病生存率和癌症特异性生存率最强的预后因素。肾周脂肪浸润是无病生存率的独立预后因素，但不是癌症特异性生存率的独立预后因素，因为小（7 cm及以下）pT3a肿瘤复发后侵袭性较小。肿瘤大小和肾周脂肪浸润应纳入pT3a肾细胞癌的分期。
