Bedke Jens, Buse Stephan, Pritsch Maria, Macher-Goeppinger Stephan, Schirmacher Peter, Haferkamp Axel, Hohenfellner Markus
Department of Medical Biometry, University of Heidelberg, Heidelberg, Germany.
BJU Int. 2009 May;103(10):1349-54. doi: 10.1111/j.1464-410X.2008.08236.x. Epub 2008 Dec 8.
To evaluate the influence of perinephric (PN) and renal sinus (RS) fat infiltration on cancer-specific survival beyond other prognostic factors, as the Tumour-Node-Metastasis (TNM) classification system defines stage T3a renal cell carcinoma (RCC) as infiltration of perirenal fat and/or direct infiltration of the adrenal gland. Perirenal fat invasion is differentiated into RS and PN fat infiltration, but not further classified for the prognosis.
From 1990 to October 2007 106 patients with advanced RCC (T3a) were followed prospectively at one academic centre; all had a radical nephrectomy. To identify prognostic effects of PN, RS or RS + PN fat infiltration, univariable and multivariable Cox proportional hazard regression models were applied, including lymph node status, metastases, presence of sarcomatoid features and tumour necrosis, Fuhrman's grade, Karnofsky performance status, and tumour size.
PN fat invasion alone was present in 58, RS in 21, and PN + RS in 27 patients. The median follow-up was 2.9 years; 49 patients died from RCC. In univariable and multivariable analyses RS fat infiltration was an unfavourable prognostic factor (adjusted hazard ratio, HR, 2.24, P = 0.019). Univariable analysis of RS + PN fat infiltration showed the worst prognostic effect (HR 3.25, P < 0.001). In multivariable analysis this combination was an independent prognostic factor (HR 2.75, P = 0.007), as was the presence of metastasis (HR 5.64, P < 0.001). In this group of RS + PN fat infiltration the 5-year cancer-specific survival was 31%.
Univariable and multivariable analyses showed that the combination of RS and PN fat infiltration is an independent unfavourable prognostic marker. We recommend that perirenal fat infiltration should be further differentiated into RS fat or PN infiltration in the TNM classification. This will better stratify patient prognosis and might allow those in need of adjuvant therapy to be identified.
肿瘤-淋巴结-转移（TNM）分类系统将T3a期肾细胞癌（RCC）定义为肾周脂肪浸润和/或肾上腺直接浸润，本研究旨在评估肾周（PN）和肾窦（RS）脂肪浸润对癌症特异性生存的影响，以明确其是否为除其他预后因素之外的影响因素。肾周脂肪浸润可分为RS和PN脂肪浸润，但尚未针对预后进行进一步分类。
1990年至2007年10月期间，一家学术中心对106例晚期RCC（T3a）患者进行了前瞻性随访；所有患者均接受了根治性肾切除术。为确定PN、RS或RS + PN脂肪浸润的预后影响，应用了单变量和多变量Cox比例风险回归模型，纳入的因素包括淋巴结状态、转移情况、肉瘤样特征和肿瘤坏死的存在情况、Fuhrman分级、卡诺夫斯基体能状态以及肿瘤大小。
58例患者仅存在PN脂肪浸润，21例存在RS脂肪浸润，27例存在PN + RS脂肪浸润。中位随访时间为2.9年；49例患者死于RCC。在单变量和多变量分析中，RS脂肪浸润是一个不利的预后因素（调整后风险比，HR，2.24，P = 0.019）。RS + PN脂肪浸润的单变量分析显示预后最差（HR 3.25，P < 0.001）。在多变量分析中，这种组合是一个独立的预后因素（HR 2.75，P = 0.007），转移的存在情况也是如此（HR 5.64，P < 0.001）。在这组RS + PN脂肪浸润患者中，5年癌症特异性生存率为31%。
单变量和多变量分析表明，RS和PN脂肪浸润的组合是一个独立的不利预后标志物。我们建议在TNM分类中，应将肾周脂肪浸润进一步细分为RS脂肪浸润或PN浸润。这将更好地分层患者预后，并可能有助于识别需要辅助治疗的患者。
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