Department of Urology, Mayo Clinic, Rochester, Minnesota 55905, USA.
J Urol. 2013 Jul;190(1):37-43. doi: 10.1016/j.juro.2013.01.044. Epub 2013 Jan 23.
We evaluated the association of microvascular and capillary-lymphatic invasion with patient outcome after nephrectomy for renal cell carcinoma.
We identified 1,433 patients surgically treated for sporadic, unilateral renal cell carcinoma between 2001 and 2008. All specimens were reviewed by a single uropathologist for microvascular and capillary-lymphatic invasion. Associations with time to metastasis and death from renal cell carcinoma were evaluated using Cox proportional hazards models, controlling for established clinicopathological prognostic variables.
Microvascular invasion and capillary-lymphatic invasion were identified in 119 (11%) and 17 (2%) of the 1,103 patients with clear cell, 5 (2%) and 1 (less than 1%) of the 219 with papillary, and 1 (1%) and 0 of the 86 with chromophobe renal cell carcinoma, respectively. Median followup in survivors was 6.4 years (range 0 to 11). In clear cell renal cell carcinoma cases microvascular invasion was univariately associated with an increased risk of metastasis and cancer specific death (HR 3.5 and 3.0, respectively, each p <0.001). However, on multivariate analysis these associations were no longer statistically significant (HR 1.2, p = 0.4 and HR 1.3, p = 0.1, respectively). Capillary-lymphatic invasion remained significantly associated with an increased risk of metastasis and death on univariate analysis (HR 15.9 and 11.6) and on multivariate analysis (HR 3.2 and HR 3.1, respectively, each p <0.001).
Microvascular invasion is associated with an increased risk of metastasis and cancer death in patients with clear cell renal cell carcinoma, although this did not remain significant after controlling for established prognostic variables. Capillary-lymphatic invasion appears to be independently associated with metastasis and cancer death even after controlling for known prognostic risk factors. However, given its rarity, this feature may prove to be of limited clinical significance.
我们评估微血管和毛细淋巴管侵犯与肾细胞癌患者肾切除术后结局的关系。
我们确定了 2001 年至 2008 年间 1433 例接受散发性单侧肾细胞癌手术治疗的患者。所有标本均由一名泌尿科病理学家对微血管和毛细淋巴管侵犯进行了评估。使用 Cox 比例风险模型评估与转移和肾细胞癌死亡时间的相关性，同时控制了已建立的临床病理预后变量。
在 1103 例透明细胞癌患者中，有 119 例（11%）和 17 例（2%）发现微血管侵犯，5 例（2%）和 1 例（<1%）在 219 例乳头状癌患者中，86 例嫌色细胞癌患者中分别有 1 例（1%）和 0 例发现毛细淋巴管侵犯。幸存者的中位随访时间为 6.4 年（0 至 11 年）。在透明细胞癌病例中，微血管侵犯与转移和癌症特异性死亡的风险增加相关（HR 分别为 3.5 和 3.0，均<0.001）。然而，在多变量分析中，这些相关性不再具有统计学意义（HR 分别为 1.2，p=0.4 和 HR 1.3，p=0.1）。在单变量分析（HR 分别为 15.9 和 11.6）和多变量分析（HR 分别为 3.2 和 3.1，均<0.001）中，毛细淋巴管侵犯仍然与转移和死亡风险增加显著相关。
微血管侵犯与透明细胞肾细胞癌患者的转移和癌症死亡风险增加相关，尽管在控制了已建立的预后变量后，这种相关性不再显著。毛细淋巴管侵犯似乎与转移和癌症死亡独立相关，即使在控制了已知的预后危险因素后也是如此。然而，由于其罕见性，该特征可能在临床上意义有限。
