Department of Urology, University of Iowa, Iowa City, Iowa, USA.
J Urol. 2010 Jul;184(1):48-52. doi: 10.1016/j.juro.2010.03.010. Epub 2010 May 15.
Recently groups reached differing conclusions when examining the prognostic significance of renal cell carcinoma perinephric and sinus fat invasion. We evaluated the impact of these pathological features on renal cell carcinoma survival and recurrence.
We identified the pathological and clinical records of 110 patients treated surgically for renal cell carcinoma with extrarenal extension at our institution between 1997 and 2007. Patients with von Hippel-Lindau disease were excluded from study. We used Kaplan-Meier survival curves with the log rank statistic to evaluate differences between groups. Cox logistic regression analysis was used to control for metastatic disease, tumor size and renal vein involvement to determine differences among the groups.
Patients with perinephric plus sinus fat invasion had worse cancer specific survival than those with perinephric or sinus fat invasion alone (p <0.005). There was no difference in cancer specific survival between those with sinus vs perinephric fat invasion (p = 0.248). On multivariate analysis perinephric plus sinus fat invasion was a significant prognostic factor for death from renal cell carcinoma compared to sinus fat invasion alone (p = 0.038).
Patients with combined renal sinus and perinephric fat invasion had a worse prognosis than those with either alone. Considerations should be made to stage these cases accordingly.
最近，在研究肾细胞癌肾周和窦脂肪浸润的预后意义时，不同的研究组得出了不同的结论。我们评估了这些病理特征对肾细胞癌生存和复发的影响。
我们在我院 1997 年至 2007 年间对接受肾外扩展肾细胞癌手术治疗的 110 例患者的病理和临床记录进行了鉴定。排除患有 von Hippel-Lindau 病的患者。我们使用 Kaplan-Meier 生存曲线和对数秩检验来评估组间差异。使用 Cox 逻辑回归分析控制转移性疾病、肿瘤大小和肾静脉受累，以确定组间差异。
肾周加窦脂肪浸润的患者比单纯肾周或窦脂肪浸润的患者有更差的癌症特异性生存（p<0.005）。窦脂肪浸润与肾周脂肪浸润的癌症特异性生存无差异（p=0.248）。多变量分析显示，与单纯窦脂肪浸润相比，肾周加窦脂肪浸润是肾细胞癌死亡的显著预后因素（p=0.038）。
与单纯窦脂肪浸润相比，同时存在肾窦和肾周脂肪浸润的患者预后更差。应相应地对这些病例进行分期。
