Sánchez de la Muela P, Zudaire J J, Robles J E, Rosell D, Aguera L, De Castro F, Isa W, Berián J M
Departamento de Urología, Clínica Universitaria, Universidad de Navarra, Pamplona.
Actas Urol Esp. 1991 May-Jun;15(3):247-52.
Ninety-nine consecutive patients with renal cell carcinoma in stages pT1-4/N0-3/V0-2/M0 were analyzed. Overall 5 year survival was 61%. Factors with greater impact on survival were: 1) degree of anaplasia (DI 73%, DII 47%, DIII 27%; p = 0.0005), 2) pathological stage (pT1-2 87%, pT3 39%; p = 0.0000), 3) perirenal fat invasion (pT1-2 87%, pT3a 60%; p = 0.007), 4) node status (N0 72%, N1-3 17%; p = 0.0000) and 5) veins invasion (V0 74%, V1-2 35%; p = 0.005). No difference in survival between V1 and V2 (40% vs 33%; p0.05) tumours was found. A multivariable study showed that the degree of anaplasia and veins invasion have a significant and separate influence on survival (p = 0.0000). Among patients with vascular invasion, those with no perirenal fat invasion or node damage show better survival rates than patients with capsular infiltration (62% vs 40%; p) and perform significantly better than patients with capsular invasion and nodal implication (62% vs 30%; p). No survival differences were observed between pT3b stages with venous invasion only and pT1-2 stages (p0.05). Venous invasion is not in itself of prognostic relevance; the prognostic significance of vascular invasion is directly related to the presence of perirenal fat invasion and/or nodal implication.
对99例分期为pT1 - 4/N0 - 3/V0 - 2/M0的肾细胞癌患者进行了分析。总体5年生存率为61%。对生存率影响较大的因素有：1) 间变程度（DI级73%，DII级47%，DIII级27%；p = 0.0005），2) 病理分期（pT1 - 2期87%，pT3期39%；p = 0.0000），3) 肾周脂肪浸润（pT1 - 2期87%，pT3a期60%；p = 0.007），4) 淋巴结状态（N0期72%，N1 - 3期17%；p = 0.0000）以及5) 静脉侵犯（V0期74%，V1 - 2期35%；p = 0.005）。未发现V1和V2期肿瘤在生存率上有差异（40%对33%；p>0.05）。一项多变量研究表明，间变程度和静脉侵犯对生存率有显著且独立的影响（p = 0.0000）。在有血管侵犯的患者中，那些没有肾周脂肪浸润或淋巴结损害的患者比有包膜浸润的患者生存率更高（62%对40%；p），并且明显优于有包膜侵犯和淋巴结受累的患者（62%对30%；p）。仅存在静脉侵犯的pT3b期与pT1 - 2期之间未观察到生存率差异（p>0.05）。静脉侵犯本身与预后无关；血管侵犯的预后意义直接与肾周脂肪浸润和/或淋巴结受累的存在相关。
