Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA.
J Urol. 2011 Jan;185(1):37-42. doi: 10.1016/j.juro.2010.08.084. Epub 2010 Nov 12.
Beginning with the 2002 American Joint Committee on Cancer staging system, renal sinus muscular venous branch invasion has prognostic equivalence with renal vein invasion in renal cell carcinoma cases. To validate this presumed equivalence we compared patients with isolated muscular venous branch invasion to those with renal vein invasion and those with no confirmed vascular invasion.
From routine cataloging at our institution we identified 500 patients who underwent partial or radical nephrectomy from 2003 to 2008. After excluding patients with metastasis or noncortical renal cell carcinoma pathology we identified 85 with positive muscular venous branch invasion (+). The 259 patients with pT1-2 muscular venous branch (-) invasion and the 71 with renal vein (+) invasion served as comparison groups. We used a multivariate Cox model to control for tumor characteristics using the Kattan renal cell carcinoma nomogram.
On multivariate analysis the risk of recurrence in the pT1-2 muscular venous branch invasion (-) group was lower than in the muscular venous branch invasion (+) group (HR 0.06, 95% CI 0.02-0.18, p < 0.001). Patients with renal vein invasion (+) had a recurrence rate similar to that in those with muscular venous branch invasion (+) (HR 0.80, 95% CI 0.39-1.65, p = 0.6). The overall survival rate was higher in the muscular venous branch invasion (-) group than in the other groups.
Patients with muscular venous branch invasion have an outcome inferior to that in patients with pT1-2 disease. This confirms the adverse prognosis of muscular venous branch invasion and supports pathological up-staging. The prognosis of muscular venous branch invasion is similar to that of renal vein invasion, although we cannot exclude the possibility of a difference. Our findings underscore the importance of close patient followup and careful pathological assessment of the nephrectomy specimen.
自 2002 年美国癌症联合委员会分期系统以来，肾窦肌静脉分支侵犯在肾细胞癌病例中与肾静脉侵犯具有同等的预后意义。为了验证这种假定的等同性，我们比较了孤立性肌静脉分支侵犯患者与肾静脉侵犯患者和无明确血管侵犯患者的情况。
从我们机构的常规目录中，我们确定了 500 名 2003 年至 2008 年间接受部分或根治性肾切除术的患者。排除转移或非皮质肾细胞癌病理患者后，我们确定了 85 名肌静脉分支阳性（+）侵犯患者。259 名 pT1-2 肌静脉分支（-）侵犯和 71 名肾静脉（+）侵犯的患者作为比较组。我们使用多变量 Cox 模型使用 Kattan 肾细胞癌诺模图控制肿瘤特征。
多变量分析显示，pT1-2 肌静脉分支侵犯（-）组的复发风险低于肌静脉分支侵犯（+）组（HR 0.06，95%CI 0.02-0.18，p <0.001）。肾静脉侵犯（+）患者的复发率与肌静脉分支侵犯（+）患者相似（HR 0.80，95%CI 0.39-1.65，p = 0.6）。肌静脉分支侵犯（-）组的总体生存率高于其他组。
肌静脉分支侵犯患者的预后不如 pT1-2 疾病患者。这证实了肌静脉分支侵犯的不良预后，并支持病理升级。肌静脉分支侵犯的预后与肾静脉侵犯相似，尽管我们不能排除存在差异的可能性。我们的研究结果强调了密切随访患者和仔细评估肾切除标本的重要性。
