Giuliani L, Giberti C, Martorana G, Rovida S
Department of Urology, University of Genoa, Italy.
J Urol. 1990 Mar;143(3):468-73; discussion 473-4. doi: 10.1016/s0022-5347(17)39992-5.
We studied 200 consecutive patients with renal cell carcinoma who underwent radical nephrectomy and extensive lymphadenectomy. Of the patients 25% already had distant metastasis at operation. Higher T stages tended to be associated with positive nodes (p less than 0.01) and distant metastasis (p less than 0.001). However, in patients with stage N0M0V0 tumors we found no statistically significant difference in survival in relationship to the T stage of the disease (5-year survival: stage T1 80%, stage T2 68% and stage T3 70%). Of all patients 10% had positive nodes without distant metastases and no venous spread of the tumor, and the 5-year survival rate was 52%. The 5-year survival rate of patients with distant metastases was 7%. Patient survival in the presence of a vena caval tumor thrombus is similar to that of patients with distant metastases. Based on our results the different stages in disease progression may be classified as having a good prognosis--intracapsular tumors (stages T1 to T2, N0M0V0) and tumors with involvement of perirenal fat (stage T3N0M0V0), an intermediate prognosis--tumors with nodal metastases alone (stages T1 to T3, N1 to 2, M0V0) and a poor prognosis--tumors with venous invasion and/or distant metastases. Histological grading and size of tumor can be used to assess prognosis but are not more accurate than pathological staging.
我们研究了200例接受根治性肾切除术和广泛淋巴结清扫术的肾细胞癌患者。其中25%的患者在手术时已有远处转移。较高的T分期往往与阳性淋巴结（p<0.01）和远处转移（p<0.001）相关。然而，在N0M0V0期肿瘤患者中，我们发现疾病的T分期与生存率之间无统计学显著差异（5年生存率：T1期80%，T2期68%，T3期70%）。所有患者中，10%有阳性淋巴结但无远处转移且肿瘤无静脉播散，其5年生存率为52%。有远处转移患者的5年生存率为7%。存在腔静脉瘤栓患者的生存率与有远处转移患者相似。根据我们的结果，疾病进展的不同阶段可分类为预后良好——包膜内肿瘤（T1至T2期，N0M0V0）和累及肾周脂肪的肿瘤（T3N0M0V0），预后中等——仅伴有淋巴结转移的肿瘤（T1至T3期，N1至2，M0V0），预后较差——伴有静脉侵犯和/或远处转移的肿瘤。组织学分级和肿瘤大小可用于评估预后，但并不比病理分期更准确。
