Bazzi Wassim M, Sjoberg Daniel D, Feuerstein Michael A, Maschino Alexandra, Verma Sweeney, Bernstein Melanie, O'Brien Matthew F, Jang Thomas, Lowrance William, Motzer Robert J, Russo Paul
Urology Service, Department of Surgery (WMB, MAF, MB, PR), Memorial Sloan Kettering Cancer Center, New York, New York; Department of Epidemiology and Biostatistics (DDS, AM), Memorial Sloan Kettering Cancer Center, New York, New York; Genitourinary Oncology Service, Division of Solid Tumor Oncology (RJM), Memorial Sloan Kettering Cancer Center, New York, New York; Department of Urology, Cork University Hospital, University College Cork (MFO), Cork, Ireland; Urology Service, Morristown Surgical Associates (TJ), Morristown, New Jersey; Division of Urology, Department of Surgery, University of Utah and Huntsman Cancer Institute (WL), Salt Lake City, Utah.
Urology Service, Department of Surgery (WMB, MAF, MB, PR), Memorial Sloan Kettering Cancer Center, New York, New York; Department of Epidemiology and Biostatistics (DDS, AM), Memorial Sloan Kettering Cancer Center, New York, New York; Genitourinary Oncology Service, Division of Solid Tumor Oncology (RJM), Memorial Sloan Kettering Cancer Center, New York, New York; Department of Urology, Cork University Hospital, University College Cork (MFO), Cork, Ireland; Urology Service, Morristown Surgical Associates (TJ), Morristown, New Jersey; Division of Urology, Department of Surgery, University of Utah and Huntsman Cancer Institute (WL), Salt Lake City, Utah.
J Urol. 2015 Jun;193(6):1911-6. doi: 10.1016/j.juro.2014.12.022. Epub 2014 Dec 15.
We analyzed the 23-year Memorial Sloan Kettering Cancer Center experience with surgical resection, and concurrent adrenalectomy and lymphadenectomy for locally advanced nonmetastatic renal cell carcinoma.
We retrospectively reviewed the records of 802 patients who underwent nephrectomy with or without concurrent adrenalectomy or lymphadenectomy for locally advanced renal cell carcinoma, defined as stage T3 or greater and M0. Patients who received adjuvant treatment within 3 months of surgery or had fewer than 3 months of followup or bilateral renal masses at presentation were excluded from analysis. Five and 10-year progression-free and overall survival was estimated by the Kaplan-Meier method. Differences between groups were analyzed by the log rank test.
A total of 596 (74%) and 206 patients (26%) underwent radical and partial nephrectomy, respectively. Renal cell carcinoma progressed in 189 patients and 104 died of the disease. Median followup in patients without progression was 4.6 years. Symptoms at presentation, ASA(®) classification, tumor stage, histological subtype, grade and lymph node status were significantly associated with progression-free and overall survival. On multivariate analysis adrenalectomy use decreased with time but lymphadenectomy use increased (OR 0.82 vs 1.16 per year). Larger tumors were associated with a higher likelihood of concurrent adrenalectomy and lymphadenectomy.
In our series of patients with locally advanced nonmetastatic renal cell carcinoma survival was favorable in those in good health who were asymptomatic at presentation with T3 tumors and negative lymph nodes. Further, there has been a trend toward more selective use of adrenalectomy and increased use of lymphadenectomy.
我们分析了纪念斯隆凯特琳癌症中心23年来对局部晚期非转移性肾细胞癌进行手术切除、同期肾上腺切除术和淋巴结清扫术的经验。
我们回顾性分析了802例接受肾切除术（伴或不伴同期肾上腺切除术或淋巴结清扫术）治疗局部晚期肾细胞癌患者的记录，局部晚期肾细胞癌定义为T3期及以上且M0期。排除在手术后3个月内接受辅助治疗、随访时间少于3个月或就诊时为双侧肾肿块的患者。采用Kaplan-Meier法估计5年和10年无进展生存率及总生存率。组间差异采用对数秩检验分析。
分别有596例（74%）和206例（26%）患者接受了根治性肾切除术和部分肾切除术。189例患者肾细胞癌病情进展，104例死于该疾病。无病情进展患者的中位随访时间为4.6年。就诊时的症状、美国麻醉医师协会（ASA）分级、肿瘤分期、组织学亚型、分级和淋巴结状态与无进展生存率及总生存率显著相关。多因素分析显示，肾上腺切除术的使用随时间减少，但淋巴结清扫术的使用增加（每年的比值比分别为0.82和1.16）。较大的肿瘤与同期肾上腺切除术和淋巴结清扫术的可能性更高相关。
在我们这组局部晚期非转移性肾细胞癌患者中，健康状况良好、就诊时无症状、T3期肿瘤且淋巴结阴性的患者生存率良好。此外，肾上腺切除术的使用有更具选择性的趋势，而淋巴结清扫术的使用有所增加。
