Ito Keiichi, Seguchi Kenji, Shimazaki Hideyuki, Takahashi Eiji, Tasaki Shinsuke, Kuroda Kenji, Sato Akinori, Asakuma Junichi, Horiguchi Akio, Asano Tomohiko
Department of Urology, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan.
Department of Laboratory Medicine, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan.
Oncol Lett. 2015 Jan;9(1):125-130. doi: 10.3892/ol.2014.2670. Epub 2014 Nov 4.
Patients with pT1aN0M0 renal cell carcinoma (RCC) generally have good prognosis, and recurrence is rare. However, metastasis develops postoperatively in a small number of patients with pT1aN0M0 RCC. The present study was undertaken to identify predictors for recurrence in patients with pT1aN0M0 RCC. We reviewed the clinicopathological factors of 133 patients with pT1aN0M0 RCC who underwent radical or partial nephrectomy at the Department of Urology, National Defense Medical College (Saitama, Japan). Clinicopathological factors, including age, gender, tumor size, histological subtype, tumor grade, microvascular invasion, histological tumor necrosis, C-reactive protein levels and performance status were reviewed. These factors were compared between patients with and without postoperative recurrence. Recurrence-free survival (RFS) and cause-specific survival (CSS) rates were calculated using the Kaplan-Meier method. Univariate and multivariate analyses were performed to determine independent factors predicting recurrence in patients with pT1aN0M0 RCC. The 5-year RFS and CSS rates were 97.2 and 99.1%, respectively. When clinicopathological factors were compared between patients with and without recurrence, tumor size (P=0.0390) and percentage of tumor necrosis (P<0.0001) were significantly different between groups. All patients with recurrence had primary lesions ≥3 cm. By univariate analysis, tumor size (P=0.0379) and the presence of tumor necrosis (P=0.0319) were significant predictors for recurrence; tumor necrosis was also an independent predictor for recurrence (P=0.0143). In patients with pT1b tumors ≤5 cm (recurrence rate, 16.8%; n=48), the percentage of tumor necrosis was significantly higher in patients with recurrence compared with those without (P=0.0261). This suggests that tumor necrosis may be an important predictor for recurrence in small RCCs. Although recurrence is rare in pT1a RCC, the presence of tumor necrosis may be an important predictor for recurrence. Particularly, patients presenting with pT1a RCC with histological tumor necrosis should undergo careful follow-up.
pT1aN0M0期肾细胞癌（RCC）患者通常预后良好，复发罕见。然而，少数pT1aN0M0期RCC患者术后会发生转移。本研究旨在确定pT1aN0M0期RCC患者复发的预测因素。我们回顾了133例在日本埼玉县国防医科大学泌尿外科接受根治性或部分肾切除术的pT1aN0M0期RCC患者的临床病理因素。回顾了包括年龄、性别、肿瘤大小、组织学亚型、肿瘤分级、微血管侵犯、组织学肿瘤坏死、C反应蛋白水平和体能状态等临床病理因素。对有术后复发和无术后复发的患者的这些因素进行了比较。采用Kaplan-Meier法计算无复发生存期（RFS）和病因特异性生存率（CSS）。进行单因素和多因素分析以确定pT1aN0M0期RCC患者复发的独立预测因素。5年RFS率和CSS率分别为97.2%和99.1%。在有复发和无复发患者之间比较临床病理因素时，肿瘤大小（P=0.0390）和肿瘤坏死百分比（P<0.0001）在两组之间有显著差异。所有复发患者的原发灶≥3 cm。单因素分析显示，肿瘤大小（P=0.0379）和肿瘤坏死的存在（P=0.0319）是复发的显著预测因素；肿瘤坏死也是复发的独立预测因素（P=0.0143）。在肿瘤≤5 cm的pT1b期患者中（复发率，16.8%；n=48），复发患者的肿瘤坏死百分比显著高于未复发患者（P=0.0261）。这表明肿瘤坏死可能是小肾癌复发的重要预测因素。虽然pT1a期RCC复发罕见，但肿瘤坏死的存在可能是复发的重要预测因素。特别是，出现组织学肿瘤坏死的pT1a期RCC患者应接受仔细随访。
