Bocardo Fajardo Gloria, Arellano Gañán Ramón, González López Lucía, Fernández González Inmaculada, Blanco González Julia, Garrido Abad Pablo, Coloma del Peso Almudena, Pereira Sanz Ignacio
Servicio de Urología, Hospital de la Princesa, Madrid, España.
Arch Esp Urol. 2009 Oct;62(8):630-8. doi: 10.4321/s0004-06142009000800004.
International TNM Staging System for renal cell carcinoma (RCC) classifies as T3b when "tumor grossly extends into the renal vein or its segmental branches, or vena cava below the diaphragm". The finding of microscopic invasion of the vein wall is not taken into account for TNM staging. We analyse its prognostic significance in localized and locally advanced RCC.
From January 1989 to July 2002, 257 RCC were surgically excised. Excluding Von Hippel-Lindau patients and stage IV (TNM 2002), 241 cases were studied in retrospect, with a median follow up of 50.96 months. Histopathological data from the renal vein were available in 216 specimens. There was renal vein wall invasion in 22. We compare the outcomes in this group vs. the group without microscopic involvement of the renal vein wall (n: 194).
Mean age for the group with renal vein invasion (RVI) was 65.02 years. Mean tumour size in the same group was 9 cm, larger than in control group (p<0,001). Thrombus was found in 72.7% vs. 6.2% in the control group. Clear cell carcinoma (77.3%) was the predominant histological subtype. Nuclear grade 2 according to Fuhrman's Classification System accounts for 42.9% of the cases. Metastatic progression risk (HR: 4,86) and death risk (HR: 6,49) are significantly higher in RVI group. When renal vein thrombosis is found, progression and death risks are still higher (HR: 7.22 and 8.38, respectively).
Microscopic invasion of the renal vein wall is a dependent prognostic factor for disease progression and death for RCC. Macroscopic renal vein involvement is an independent prognostic factor. When both factors are found together, disease outcome is worse.
国际肾癌（RCC）TNM分期系统将“肿瘤肉眼侵犯肾静脉或其分支，或侵犯膈肌以下的下腔静脉”归为T3b期。TNM分期未考虑静脉壁的镜下侵犯情况。我们分析其在局限性和局部进展性RCC中的预后意义。
1989年1月至2002年7月，257例RCC接受手术切除。排除冯·希佩尔-林道病患者和IV期（TNM 2002）患者后，对241例进行回顾性研究，中位随访时间为50.96个月。216份标本有肾静脉的组织病理学数据。其中22例存在肾静脉壁侵犯。我们比较该组与无肾静脉壁镜下侵犯组（n = 194）的结局。
肾静脉侵犯（RVI）组的平均年龄为65.02岁。该组的平均肿瘤大小为9 cm，大于对照组（p<0.001）。RVI组血栓发生率为72.7%，而对照组为6.2%。透明细胞癌（77.3%）是主要的组织学亚型。根据福尔曼分类系统，核分级2级占病例的42.9%。RVI组的转移进展风险（HR：4.86）和死亡风险（HR：6.49）显著更高。当发现肾静脉血栓形成时，进展和死亡风险仍然更高（分别为HR：7.22和8.38）。
肾静脉壁的镜下侵犯是RCC疾病进展和死亡的独立预后因素。肉眼可见的肾静脉受累是独立的预后因素。当这两个因素同时存在时，疾病结局更差。
