Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
J Urol. 2010 Mar;183(3):909-14. doi: 10.1016/j.juro.2009.11.010. Epub 2010 Jan 18.
Tumor necrosis is a potential marker of recurrence and survival after surgery for renal cell carcinoma. We determined whether a correlation exists between the amount (not just the presence/absence) of tumor necrosis, and metastasis-free, disease specific and overall survival after surgery for renal cell carcinoma.
We identified 841 consecutive patients who underwent partial or radical nephrectomy from 1989 to 2004 for renal cell cancer. Specimens were re-reviewed by a single pathologist (MFS). The tumor necrosis percent was none in 586 cases, less than 50% in 198 and 50% or greater in 55. Grade, stage, subtype, size, gender and age were also analyzed. Variables at p <0.05 on univariate analysis were incorporated into a Cox proportional hazards multivariate model. Metastasis-free, disease specific and overall survival was described using the Kaplan-Meier method and compared with the log rank test.
Tumor necrosis was found in 253 specimens (30%). Univariate analysis revealed that the percent and presence of tumor necrosis correlated with metastasis-free, disease specific and overall survival. On multivariate analysis tumor necrosis presence/absence did not remain an independent predictor of disease specific (p = 0.7), metastasis-free (p = 0.7) or overall (p = 0.2) survival. Greater than 50% tumor necrosis was no longer a statistically significant predictor of metastasis-free survival (p = 0.45) but remained significant for disease specific (p = 0.02) and overall (p = 0.01) survival.
The presence of 50% or greater tumor necrosis correlates with worse disease specific and overall survival but not metastasis-free survival in patients with renal cell carcinoma. Results support the inclusion of percent tumor necrosis over the presence/absence of tumor necrosis in the risk assessment of patients who undergo surgical treatment for renal cell carcinoma.
肿瘤坏死是肾细胞癌手术后复发和生存的潜在标志物。我们确定肿瘤坏死的量（不仅仅是存在/不存在）与肾细胞癌手术后无转移、疾病特异性和总生存率之间是否存在相关性。
我们从 1989 年至 2004 年期间确定了 841 例连续接受部分或根治性肾切除术治疗肾细胞癌的患者。标本由一名病理学家（MFS）进行重新审查。586 例肿瘤无坏死，198 例肿瘤坏死小于 50%，55 例肿瘤坏死等于或大于 50%。还分析了肿瘤分级、分期、亚型、大小、性别和年龄等变量。单因素分析中 p 值<0.05 的变量被纳入 Cox 比例风险多因素模型。使用 Kaplan-Meier 方法描述无转移、疾病特异性和总生存率，并与对数秩检验进行比较。
253 例标本（30%）中发现肿瘤坏死。单因素分析显示，肿瘤坏死的百分比和存在与无转移、疾病特异性和总生存率相关。多因素分析显示，肿瘤坏死的存在/不存在不再是疾病特异性（p=0.7）、无转移（p=0.7）或总生存（p=0.2）的独立预测因素。肿瘤坏死大于 50%不再是无转移生存的统计学显著预测因子（p=0.45），但仍然是疾病特异性（p=0.02）和总生存（p=0.01）的显著预测因子。
肾细胞癌患者肿瘤坏死 50%或以上与疾病特异性和总生存率较差相关，但与无转移生存率无关。结果支持在对接受肾细胞癌手术治疗的患者进行风险评估时，将肿瘤坏死百分比纳入存在/不存在肿瘤坏死之外的因素。
