Division of Oncology, Department of Internal Medicine, Medical University of Graz (MUG), Auenbruggerplatz 25, 8036 Graz, Austria.
Int Urol Nephrol. 2012 Aug;44(4):997-1004. doi: 10.1007/s11255-012-0165-5. Epub 2012 Mar 29.
To assess renal cell carcinoma (RCC) stage migration in a large European academic centre series over 25 years and its possible impact on patients' metastasis-free survival.
The pathology reports of 2,333 consecutive patients with RCC who underwent nephrectomy from 1984 to 2006 at our institution were systematically re-evaluated. Patients were pooled into four groups according to the date of surgery: group 1: 1984-1989, group 2: 1990-1995, group 3: 1996-2001 and group 4: 2002-2006, respectively. Changes in pT-categories over time and the impact on 5- and 10-year metastasis-free survival were evaluated.
Organ-confined (pT1 and pT2) tumours were found in 191/502 (38.0 %) and 372/535 (69.5 %) surgical specimens in groups 1 and 4, respectively (p < 0.001). This stage migration was mainly the result of an increase in pT1a tumours (overall: 32.6 %) from 12.5 % in group 1 to 45.8 % in group 4 and a decrease in pT3a tumours (overall: 24.1 %) from 46.6 % in group 1 to 11.0 % in group 4 (p < 0.001). The mean tumour size decreased from 6.7 cm in group 1 to 4.8 cm in group 4 (p < 0.001). In 2,152 patients with non-metastatic RCC, median follow-up was 76.2 (interquartile range: 36.2-133.9) months. Five- and 10-year metastasis-free survival probabilities were 78.7 and 71.9 % in group 1, 85.3 and 80.0 % in group 2, and 86.9 and 82.7 % in group 3, respectively. Five-year metastasis-free survival in group 4 was 90.3 % (p < 0.001).
A statistically significant stage migration towards organ-confined RCC was observed in the cohort studied. This stage migration was accompanied by a significant improvement in metastasis-free survival comparing the period 1984-1989 and following time periods.
评估 25 年来一家大型欧洲学术中心系列中肾细胞癌（RCC）的分期迁移及其对患者无转移生存的可能影响。
我们对 1984 年至 2006 年间在我院接受肾切除术的 2333 例连续 RCC 患者的病理报告进行了系统评估。患者根据手术日期分为 4 组：组 1：1984-1989 年；组 2：1990-1995 年；组 3：1996-2001 年；组 4：2002-2006 年。评估了随时间推移的 pT 分类变化及其对 5 年和 10 年无转移生存的影响。
1 组和 4 组的手术标本中，器官局限性（pT1 和 pT2）肿瘤分别为 191/502（38.0%）和 372/535（69.5%）（p<0.001）。这种分期迁移主要是由于 pT1a 肿瘤的增加（总体：32.6%）所致，从 1 组的 12.5%增加到 4 组的 45.8%，pT3a 肿瘤的减少（总体：24.1%）从 1 组的 46.6%减少到 4 组的 11.0%（p<0.001）。肿瘤的平均大小从 1 组的 6.7cm 缩小到 4 组的 4.8cm（p<0.001）。在 2152 例非转移性 RCC 患者中，中位随访时间为 76.2（四分位间距：36.2-133.9）个月。1 组、2 组和 3 组的 5 年和 10 年无转移生存率分别为 78.7%和 71.9%、85.3%和 80.0%以及 86.9%和 82.7%。4 组的 5 年无转移生存率为 90.3%（p<0.001）。
在本研究中，观察到肾细胞癌向器官局限性肿瘤的统计学显著分期迁移。这种分期迁移伴随着无转移生存的显著改善，与 1984-1989 年及之后的时间段相比。
