Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
BJU Int. 2012 Dec;110(11 Pt B):E673-8. doi: 10.1111/j.1464-410X.2012.11498.x. Epub 2012 Sep 14.
What's known on the subject? and What does the study add? In patients with pRCC, the presence of venous tumour thrombus is known to be a predictor of poorer outcomes. However, a paucity of data is available regarding the prognostic significance of histology in patients with RCC and IVC thrombus. In our series, we found that patients with type II pRCC had significantly poorer outcomes when compared to those with cRCC. Although the lack of effective treatment for patients with metastatic pRCC may have contributed to these adverse outcomes, type II papillary histology was independent predictor not only of CSS but also of RFS.
• To analyze the prognostic impact of papillary histology on oncological outcomes in patients with renal cell carcinoma (RCC) and inferior vena cava (IVC) thrombus.
• We reviewed the medical records of 74 patients who underwent radical nephrectomy and IVC thrombectomy between 1990 and 2010 for clear cell or papillary RCC. • We compared the clinicopathological features and clinical outcomes of 62 patients with clear cell RCC (cRCC) and 12 with papillary RCC (pRCC). • All cases of pRCC were subdivided into type I or type II. • The prognostic role of papillary histology on recurrence-free survival (RFS) and cancer-specific survival (CSS) was estimated using Cox's regression models.
• Upon reclassification of the pRCC subtype, all 12 patients with pRCC had type II tumours. • Patients with type II pRCC were significantly younger (P=0.028) and were more probably women (P=0.025) than those with cRCC • The 2- and 5-year CSS rates were 81.1% and 53.6% in cRCC patients, and 28.1% and 0% in type II pRCC patients, respectively. All eight patients with non-metastatic type II pRCC developed disease recurrence at a median interval of 6 months after surgery, whereas 25 of 44 (56.8%) patients with non-metastatic cRCC experienced such recurrence at a median interval of 10 months after surgery. • Patients with type II pRCC showed significantly lower CSS (P<0.001) and RFS (P=0.002) than those with cRCC. • On multivariate analysis, type II papillary histology was an independent predictor of CSS (hazard ratio, 3.73; P=0.003) and RFS (hazard ratio, 3.15; P=0.015).
• Type II papillary histology appears to be predominant in cases of pRCC with IVC thrombus. • Patients with type II pRCC who presented with IVC thrombus had significantly worse outcomes than those with cRCC, and histology is an important prognostic factor in patients with RCC and IVC thrombus.
在肾嫌色细胞癌（pRCC）患者中，静脉肿瘤血栓的存在被认为是预后不良的预测因素。然而，关于伴有 IVC 血栓的 RCC 患者的组织学预后意义的数据却很少。在我们的研究中，我们发现与 cRCC 患者相比，II 型 pRCC 患者的结局明显较差。尽管转移性 pRCC 患者缺乏有效治疗可能导致了这些不良结局，但 II 型乳头状组织学不仅是 CSS 的独立预测因素，也是 RFS 的独立预测因素。
分析乳头状组织学对肾细胞癌（RCC）伴下腔静脉（IVC）血栓患者肿瘤学结局的预后影响。
我们回顾了 1990 年至 2010 年间接受根治性肾切除术和 IVC 血栓切除术的 74 例 clear cell 或乳头状 RCC 患者的病历。我们比较了 62 例 clear cell RCC（cRCC）患者和 12 例乳头状 RCC（pRCC）患者的临床病理特征和临床结局。所有 pRCC 病例均进一步分为 I 型或 II 型。使用 Cox 回归模型估计乳头状组织学对无复发生存率（RFS）和癌症特异性生存率（CSS）的预后作用。
经 pRCC 亚型重新分类后，所有 12 例 pRCC 患者均为 II 型肿瘤。与 cRCC 患者相比，II 型 pRCC 患者明显更年轻（P=0.028），女性比例更高（P=0.025）。cRCC 患者的 2 年和 5 年 CSS 率分别为 81.1%和 53.6%，而 II 型 pRCC 患者分别为 28.1%和 0%。所有 8 例非转移性 II 型 pRCC 患者在手术后 6 个月内均出现疾病复发，而 44 例非转移性 cRCC 患者中有 25 例在手术后 10 个月内出现疾病复发。与 cRCC 患者相比，II 型 pRCC 患者的 CSS（P<0.001）和 RFS（P=0.002）显著较低。多变量分析显示，II 型乳头状组织学是 CSS（危险比，3.73；P=0.003）和 RFS（危险比，3.15；P=0.015）的独立预测因素。
在伴有 IVC 血栓的 pRCC 病例中，II 型乳头状组织学似乎更为常见。伴有 II 型 pRCC 的 IVC 血栓患者的结局明显较 cRCC 患者差，组织学是 RCC 伴 IVC 血栓患者的重要预后因素。
