Jung Soo Jin, Ro Jae Y, Truong Luan D, Ayala Alberto G, Shen Steven S
Department of Pathology, The Methodist Hospital and Research Institute, and Weill Medical College of Cornell University, Houston, TX 77030, USA.
Hum Pathol. 2008 Nov;39(11):1689-94. doi: 10.1016/j.humpath.2008.04.011. Epub 2008 Jul 24.
T3 renal cell carcinoma (RCC) is a heterogeneous group of tumors that are substaged based on perirenal or sinus fat invasion, adrenal invasion, and renal vein invasion. To evaluate whether the extent of fat invasion (minimal versus extensive) and direct adrenal gland invasion, renal vein invasion with or without concurrent fat invasion has a similar prognosis, we retrospectively reviewed 198 T3N0/NxM0 RCCs in a single academic tertiary hospital. Fat invasion was subdivided as minimal (< or =5 mm into the fat) or extensive (>5 mm) invasion. Direct adrenal invasion was defined as contiguous involvement of ipsilateral adrenal gland. Among the 198 T3 RCCs, minimal and extensive fat invasions were identified in 57 and 61 cases, respectively; renal vein invasion and direct adrenal invasion were seen in 66 and 14 cases. The patients' average age was 62.9 years, and 145 patients were male and 53 were females. The 2-year and 5-year survival rates were 85% and 56% for minimal fat invasion, 76% and 70% for extensive fat invasion, and 55% and 32% for renal vein invasion, respectively. There was no difference of survival in patients with T3b (renal vein invasion) RCC stratified by presence or absence of concurrent fat invasion. The 2-year and 5-year survival rates for adrenal invasion were 31% and 21%, respectively, which was significantly worse than that of fat or renal vein invasion. Multivariate analysis showed that nuclear grade, sarcomatoid differentiation, and subgrouping of pT3 RCC (fat invasion, renal vein invasion, and adrenal invasion) remained independent predictors of patient's overall survival. In conclusion, our study shows that T3 RCCs with minimal or extensive perinephric fat invasion has a similar prognosis and is significantly more favorable than that of renal vein invasion regardless of presence or absence of concurrent fat invasion. In contrast, tumors with adrenal gland invasion carry a far worse prognosis than perinephric fat or renal vein invasion and thus supporting a separate stage category.
T3期肾细胞癌（RCC）是一组异质性肿瘤，根据肾周或肾窦脂肪浸润、肾上腺浸润和肾静脉浸润进行亚分期。为了评估脂肪浸润程度（轻微与广泛）以及直接肾上腺浸润、有无并发脂肪浸润的肾静脉浸润是否具有相似的预后，我们在一家单一的学术三级医院对198例T3N0/NxM0期RCC进行了回顾性研究。脂肪浸润分为轻微（脂肪内浸润≤5mm）或广泛（>5mm）浸润。直接肾上腺浸润定义为同侧肾上腺的连续受累。在198例T3期RCC中，分别有57例和61例出现轻微和广泛脂肪浸润；66例和14例出现肾静脉浸润和直接肾上腺浸润。患者的平均年龄为62.9岁，男性145例，女性53例。轻微脂肪浸润患者的2年和5年生存率分别为85%和56%，广泛脂肪浸润患者为76%和70%，肾静脉浸润患者为55%和32%。T3b期（肾静脉浸润）RCC患者中，有无并发脂肪浸润的生存率无差异。肾上腺浸润患者的2年和5年生存率分别为31%和21%，明显低于脂肪或肾静脉浸润患者。多因素分析显示，核分级、肉瘤样分化以及pT3期RCC的亚分组（脂肪浸润、肾静脉浸润和肾上腺浸润）仍然是患者总生存的独立预测因素。总之，我们的研究表明，伴有轻微或广泛肾周脂肪浸润的T3期RCC预后相似，且无论有无并发脂肪浸润，均明显优于肾静脉浸润。相比之下，肾上腺浸润的肿瘤预后远比肾周脂肪或肾静脉浸润差，因此支持单独设立一个分期类别。
