Department of Urology, Mayo Clinic, Rochester, Minnesota 55905, USA.
J Urol. 2010 Apr;183(4):1309-15. doi: 10.1016/j.juro.2009.12.035. Epub 2010 Feb 19.
There are significant differences in clinicopathological features among renal cell carcinoma histological subtypes but controversy exists regarding the independent impact of histological subtype on patient outcome after nephrectomy. We examined the significance of histological subtype on progression to distant metastasis and cancer specific death after nephrectomy.
In a retrospective review of our institutional nephrectomy registry we identified 3,062 patients treated surgically for clear cell, papillary or chromophobe renal cell carcinoma between 1970 and 2003.
We identified 2,466 patients (80.5%) with clear cell, 438 (14.3%) with papillary and 158 (5.2%) with chromophobe renal cell carcinoma. There were significant differences in age at surgery, gender, symptoms at presentation, tumor size, stage and grade, tumor necrosis, sarcomatoid differentiation and multifocality among the 3 renal cell carcinoma subtypes (p <0.01 for all). A significant difference in metastasis-free and cancer specific survival existed between patients with clear cell renal cell carcinoma and the 2 other subtypes, although no significant difference in these outcomes was identified between patients with the papillary and chromophobe subtypes. The clear cell renal cell carcinoma subtype remained a significant predictor of metastasis (HR 2.76, 95% CI 2.05-3.73) and cancer specific death (HR 1.77, 95% CI 1.38-2.26, each p <0.001) after multivariate adjustment for the features listed above.
Histological subtype is an independent predictor of progression to distant metastasis and cancer specific death in patients with renal cell carcinoma.
肾细胞癌组织学亚型的临床病理特征存在显著差异，但组织学亚型对肾切除术后患者结局的独立影响仍存在争议。本研究旨在探讨组织学亚型对肾细胞癌患者肾切除术后远处转移和癌症特异性死亡的影响。
我们对机构肾切除术登记处进行了回顾性研究，共纳入 1970 年至 2003 年间接受手术治疗的透明细胞癌、乳头状癌或嫌色细胞癌患者 3062 例。
我们发现 2466 例（80.5%）为透明细胞癌，438 例（14.3%）为乳头状癌，158 例（5.2%）为嫌色细胞癌。3 种肾细胞癌亚型在手术时年龄、性别、临床表现、肿瘤大小、分期和分级、肿瘤坏死、肉瘤样分化和多灶性等方面存在显著差异（p 值均＜0.01）。与其他 2 种亚型相比，透明细胞癌患者在无转移生存和癌症特异性生存方面存在显著差异，但在乳头状癌和嫌色细胞癌患者之间未发现这些生存结局存在显著差异。多因素校正上述特征后，透明细胞癌亚型仍然是远处转移（HR 2.76，95%CI 2.05-3.73）和癌症特异性死亡（HR 1.77，95%CI 1.38-2.26，p 值均＜0.001）的独立预测因素。
组织学亚型是肾细胞癌患者发生远处转移和癌症特异性死亡的独立预测因素。
