Sameh Wael M, Hashad Mohammed M, Eid Ahmed A, Abou Yousif Tamer A, Atta Mohammed A
Department of Urology, Faculty of Medicine, University of Alexandria, Egypt.
Arab J Urol. 2012 Jun;10(2):131-7. doi: 10.1016/j.aju.2011.12.007. Epub 2012 Feb 18.
Recurrence rates for patients with locally advanced renal cell carcinoma (LARCC) remain high. To date the predictors of recurrence in those patients remain controversial. The aim of the present study was to assess the relapse pattern in those patients and identify predictors for recurrence.
We evaluated retrospectively 112 consecutive patients who underwent surgery for LARCC (T3-T4N0M0) between January 2000 and December 2010. Clinical and pathological data were collected from hospital medical records and compiled into a computerized database. Studied variables were age, mode of presentation, Tumour-Node-Metastasis (TNM) stage, Fuhrman nuclear grade, histological subtype, tumour size, venous thrombus level, collecting-system invasion and sarcomatoid differentiation. Recurrence-free survival (RFS) was estimated using the Kaplan-Meier method. Univariate and multivariate analyses were conducted.
Patients were followed for a mean and median follow-up of 33 and 24 months, respectively, after surgery. During the follow-up, recurrences (distant and/or local) were recorded in 58 patients, representing 52% of the cohort. The mean and median times to recurrence were 25 and 13 months, respectively. Sites of recurrence were multiple in 36 patients (62%), lung only in 14 (24%), and local in eight (14%). RFS rates at 1, 2, and 5 years were 50%, 43% and 34%, respectively, while the median RFS was 23.7 months. Using univariate analysis, RFS after nephrectomy was significantly shorter in patients aged <70 years, symptomatic at presentation, with larger tumours, higher nuclear grade, collecting-system invasion, and/or sarcomatoid differentiation. After multivariate analysis, T-stage, nuclear grade and sarcomatoid differentiation retained their power as independent predictors of RFS (P = 0.032, <0.001 and 0.003, respectively).
For patients with LARCC, T-stage, grade and sarcomatoid differentiation independently dictate the risk of tumour recurrence. Considering these variables in the postoperative surveillance protocols and in the need for a multimodal therapeutic approach is highly recommended.
局部晚期肾细胞癌（LARCC）患者的复发率仍然很高。迄今为止，这些患者复发的预测因素仍存在争议。本研究的目的是评估这些患者的复发模式并确定复发的预测因素。
我们回顾性评估了2000年1月至2010年12月期间连续接受LARCC（T3 - T4N0M0）手术的112例患者。从医院病历中收集临床和病理数据，并编入计算机化数据库。研究的变量包括年龄、表现方式、肿瘤-淋巴结-转移（TNM）分期、富尔曼核分级、组织学亚型、肿瘤大小、静脉血栓水平、集合系统侵犯和肉瘤样分化。无复发生存期（RFS）采用Kaplan-Meier法估计。进行单因素和多因素分析。
患者术后平均随访33个月，中位随访24个月。随访期间，58例患者出现复发（远处和/或局部），占队列的52%。复发的平均时间和中位时间分别为25个月和13个月。36例患者（62%）复发部位为多处，14例（24%）仅为肺部，8例（14%）为局部复发。1年、2年和5年的RFS率分别为50%、43%和34%，而中位RFS为23.7个月。单因素分析显示，年龄<70岁、表现为症状性、肿瘤较大、核分级较高、集合系统侵犯和/或肉瘤样分化的患者肾切除术后RFS显著缩短。多因素分析后，T分期、核分级和肉瘤样分化仍然是RFS的独立预测因素（P分别为0.032、<0.001和0.003）。
对于LARCC患者，T分期、分级和肉瘤样分化独立决定肿瘤复发风险。强烈建议在术后监测方案以及多模式治疗方法的需求中考虑这些变量。
