University of Padua, Padua, Italy.
Eur Urol. 2010 Oct;58(4):588-95. doi: 10.1016/j.eururo.2010.07.006. Epub 2010 Jul 23.
A new edition of the TNM was recently released that includes modifications for the staging system of kidney cancers. Specifically, T2 cancers were subclassified into T2a and T2b (< or =10 cm vs >10 cm), tumors with renal vein involvement or perinephric fat involvement were classified as T3a cancers, and those with adrenal involvement were classified as T4 cancers.
Our aim was to validate the recently released edition of the TNM staging system for primary tumor classification in kidney cancer.
DESIGN, SETTING, AND PARTICIPANTS: Our multicenter retrospective study consisted of 5339 patients treated in 16 academic Italian centers.
Patients underwent either radical or partial nephrectomy.
Univariable and multivariable Cox regression models addressed cancer-specific survival (CSS) after surgery.
In the study, 1897 patients (35.5%) were classified as pT1a, 1453 (27%) as pT1b, 437 (8%) as pT2a, 153 (3%) as pT2b, 1059 (20%) as pT3a, 117 (2%) as pT3b, 26 (0.5%) as pT3c, and 197 (4%) as pT4. At a median follow-up of 42 mo, 786 (15%) had died of disease. In univariable analysis, patients with pT2b and pT3a tumors had similar CSS, as did patients with pT3c and pT4 tumors. Moreover, both pT3a and pT3b stages included patients with heterogeneous outcomes. In multivariable analysis, the novel classification of the primary tumor was a powerful independent predictor of CSS (p for trend <0.0001). However, the substratification of pT1 tumors did not retain an independent predictive role. The major limitations of the study are retrospective design, lack of central pathologic review, and the small number of patients included in some substages.
The recently released seventh edition of the primary tumor staging system for kidney tumors is a powerful predictor of CSS. However, some of the substages identified by the classification have overlapping prognoses, and other substages include patients with heterogeneous outcomes. The few modifications included in this edition may have not resolved the most critical issues in the previous version.
最近发布了新版 TNM，其中包括对肾癌分期系统的修改。具体而言，T2 肿瘤被细分为 T2a 和 T2b（≤10cm 与＞10cm），肾静脉受累或肾周脂肪受累的肿瘤被归类为 T3a 肿瘤，肾上腺受累的肿瘤被归类为 T4 肿瘤。
我们旨在验证最近发布的肾癌原发肿瘤分类 TNM 分期系统。
设计、地点和参与者：我们的多中心回顾性研究包括 16 个意大利学术中心的 5339 名患者。
患者接受根治性或部分肾切除术。
单变量和多变量 Cox 回归模型用于分析手术后的癌症特异性生存（CSS）。
在这项研究中，1897 名患者（35.5%）被归类为 pT1a，1453 名（27%）为 pT1b，437 名（8%）为 pT2a，153 名（3%）为 pT2b，1059 名（20%）为 pT3a，117 名（2%）为 pT3b，26 名（0.5%）为 pT3c，197 名（4%）为 pT4。中位随访 42 个月时，786 名（15%）患者死于疾病。单变量分析显示，pT2b 和 pT3a 肿瘤患者的 CSS 相似，pT3c 和 pT4 肿瘤患者的 CSS 也相似。此外，pT3a 和 pT3b 期均包含结局不同的患者。多变量分析显示，原发肿瘤的新分类是 CSS 的有力独立预测因素（趋势检验 p<0.0001）。然而，pT1 肿瘤的亚分期没有保留独立的预测作用。该研究的主要局限性是回顾性设计、缺乏中心病理复查以及纳入的一些亚分期患者数量较少。
最近发布的第七版肾癌原发肿瘤分期系统是 CSS 的有力预测因素。然而，该分类确定的一些亚分期具有重叠的预后，其他亚分期包含结局不同的患者。该版本中包含的少数修改可能没有解决前一版本中最关键的问题。
