Yasunaga Yutaka, Komori Kazuhiko, Harada Yasunori, Tohda Akira, Oka Toshitsugu
Department of Urology, National Hospital Organization Osaka National Hospital.
Nihon Hinyokika Gakkai Zasshi. 2012 May;103(3):540-7. doi: 10.5980/jpnjurol.103.540.
To validate 2009 TNM classification (7th edition) of renal cell carcinoma (RCC), we reevaluated our RCC database depends on 6th and 7th TNM staging and analyzed a prognostic divergence between subgroups.
A study population of 350 patients with RCC was retrospectively reviewed based on the TNM classification both 6th and 7th editions. Cause-specific survival (CSS) in each group was estimated using Kaplan-Meier method.
Applying the new TNM system, 336 patients were divided into pT1a 131, pT1b 105, pT2a 31, pT2b 13, pT3 a 38, pT3b 3, pT3c 0, pT4 14. Previously pT3b-staged 11 cases with renal vein involvement without vena caval extension were included into pT3a. Due to the positive direct invasion into the adrenal gland, previously pT3-staged six patients were changed to pT4. Kaplan-Meier curves revealed no significant differences in CSS between each a/b subgroups from pT1 to pT3. Particularly, no significant statistical value was recognized between pT2a and pT2b subgroups. Patients with direct adrenal invasion tended to show a less favorable prognosis than those with invasion beyond Gerota.
(1) pT2 subdivision does not affect prognostic value. (2) Population imbalance is enhanced due to the pT 3 reclassification. (3) Direct adrenal invasion is compatible with pT4 category.
为验证2009年肾细胞癌（RCC）的TNM分类（第7版），我们依据第6版和第7版TNM分期重新评估了我们的RCC数据库，并分析了各亚组之间的预后差异。
基于第6版和第7版TNM分类，对350例RCC患者的研究人群进行回顾性分析。采用Kaplan-Meier法估计每组的特定病因生存率（CSS）。
应用新的TNM系统，336例患者被分为pT1a 131例、pT1b 105例、pT2a 31例、pT2b 13例、pT3a 38例、pT3b 3例、pT3c 0例、pT4 14例。先前分期为pT3b的11例肾静脉受累但无腔静脉扩展的病例被纳入pT3a。由于直接侵犯肾上腺呈阳性，先前分期为pT3的6例患者被改为pT4。Kaplan-Meier曲线显示，从pT1到pT3的各a/b亚组之间的CSS无显著差异。特别是，pT2a和pT2b亚组之间未发现显著的统计学差异。直接侵犯肾上腺的患者预后往往比侵犯肾周筋膜以外的患者差。
（1）pT2细分不影响预后价值。（2）由于pT3重新分类，人群不平衡加剧。（3）直接侵犯肾上腺与pT4类别相符。
