Sánchez de la Muela P, Zudaire J J, Robles J E, Rosell D, Aguera L, De Castro F, Isa W, Berián J M
Department of Urology, Navarra University, Pamplona, Spain.
Eur Urol. 1991;19(4):284-90. doi: 10.1159/000473644.
Ninety-one consecutive patients with renal cell carcinoma stages pT1-4/N0-3/V0-2/M0 were analyzed for survival rates. The overall 5-year survival was 57%. Factors which made an impact on 5-year survival rates were: (1) grade of anaplasia (GI: 72%, GII: 42%, GIII: 22%; p = 0.0001); (2) pathological stage (pT1-2: 86%, pT3: 30%; p = 0.0000); (3) perinephric fat invasion (pT1-2: 86%, pT3a: 61%; p = 0.01); (4) nodal involvement (N0: 69%, N1: 11%; p = 0.0000), and (5) venous invasion (V0: 72%, V1-2: 30%; p less than 0.01). There were no differences in survival rates between V1 and V2 tumors (p greater than 0.05). Using multivariate statistical analysis we found that grade of anaplasia and venous invasion contained dire prognostic information (p = 0.0000). Among patients with stage pT3b, those without perinephric fat invasion or nodal involvement had a better survival rate than those with capsular infiltration (p less than 0.01) and a significantly better rate than those with perinephric fat invasion and nodal involvement (p less than 0.01). Moreover, there were no differences between stages pT3b with venous invasion only and stages pT1-2 (p greater than 0.05). Patients with venous invasion developed distant metastases with a significantly higher frequency than those without (p = 0.01). The prognostic impact of venous invasion is unclear yet, but is probably related to perinephric fat invasion and nodal involvement. Until further data are collected, the radical approach with complete removal of the thrombus remains the treatment of choice for localized renal cell carcinoma with vena caval extension.(ABSTRACT TRUNCATED AT 250 WORDS)
对91例连续的肾细胞癌患者（分期为pT1 - 4/N0 - 3/V0 - 2/M0）进行生存率分析。总体5年生存率为57%。对5年生存率有影响的因素包括：（1）间变程度（GⅠ：72%，GⅡ：42%，GⅢ：22%；p = 0.0001）；（2）病理分期（pT1 - 2：86%，pT3：30%；p = 0.0000）；（3）肾周脂肪浸润（pT1 - 2：86%，pT3a：61%；p = 0.01）；（4）淋巴结受累情况（N0：69%，N1：11%；p = 0.0000），以及（5）静脉侵犯（V0：72%，V1 - 2：30%；p＜0.01）。V1期和V2期肿瘤的生存率无差异（p＞0.05）。通过多变量统计分析，我们发现间变程度和静脉侵犯包含不良预后信息（p = 0.0000）。在pT3b期患者中，无肾周脂肪浸润或淋巴结受累的患者生存率高于有包膜浸润的患者（p＜0.01），且显著高于有肾周脂肪浸润和淋巴结受累的患者（p＜0.01）。此外，仅伴有静脉侵犯的pT3b期与pT1 - 2期之间无差异（p＞0.05）。有静脉侵犯的患者发生远处转移的频率显著高于无静脉侵犯的患者（p = 0.01）。静脉侵犯的预后影响尚不清楚，但可能与肾周脂肪浸润和淋巴结受累有关。在收集到更多数据之前，彻底清除血栓的根治性方法仍是伴有腔静脉延伸的局限性肾细胞癌的首选治疗方法。（摘要截选至250字）
