Ohtaki Yoichi, Shimizu Kimihiro, Aokage Keiju, Nakao Masayuki, Yoshida Junji, Kamiyoshihara Mitsuhiro, Sugano Masayuki, Takahashi Yusuke, Nakazawa Seshiru, Nagashima Toshiteru, Obayashi Kai, Hishida Tomoyuki, Tsuboi Masahiro, Mori Shohei, Mun Mingyon, Okumura Sakae, Igai Hitoshi, Matsutani Noriyuki, Mogi Akira, Kuwano Hiroyuki
Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, Maebashi, Gunma, Japan.
Department of Thoracic and Visceral Organ Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
World J Surg. 2017 Mar;41(3):771-779. doi: 10.1007/s00268-016-3802-9.
There are only a few detailed reports concerning the prognosticators following surgical resection of pulmonary metastases (PMs) from renal cell carcinoma (RCC). We investigated the prognosis of patients with RCC PMs undergoing pulmonary metastasectomy and identified prognostic factors in a multi-institutional retrospective study.
We retrospectively evaluated 84 patients who underwent resection of PMs from RCC between 1993 and 2014. We assessed the clinicopathological characteristics, focusing on the histological findings of PMs. We classified the histology into three types: pure clear cell carcinoma (N = 68), clear cell carcinoma combined with other histology type (N = 8), and non-clear cell carcinoma (N = 8). We examined the relationship between these histological types and the prognosis of patients with PMs from RCC.
Complete resection was achieved in 78 patients (93%). The 5-year overall survival rate after metastasectomy was 59.7%. In multivariate analysis, three factors were found to be independent favorable prognostic factors of overall survival after lung metastasectomy [tumor size <2 cm, hazard ratio (HR) = 0.31, 95% confidence interval (CI) 0.13-0.78, P = 0.012; clear cell type, HR = 0.37, 95% CI 0.16-0.83, P = 0.025; and complete resection, HR = 0.27, 95% CI 0.10-0.78, P = 0.015].
This study indicates that a histological finding of the clear cell type is a significant favorable prognostic factor in addition to complete resection and a tumor size <2 cm. Histological evaluation of PM lesions is important for predicting survival after metastasectomy.
关于肾细胞癌（RCC）肺转移瘤（PMs）手术切除后的预后因素，仅有少数详细报告。我们在一项多机构回顾性研究中，调查了接受肺转移瘤切除术的RCC患者的预后，并确定了预后因素。
我们回顾性评估了1993年至2014年间84例接受RCC肺转移瘤切除术的患者。我们评估了临床病理特征，重点是肺转移瘤的组织学表现。我们将组织学分为三种类型：纯透明细胞癌（N = 68）、透明细胞癌合并其他组织学类型（N = 8）和非透明细胞癌（N = 8）。我们研究了这些组织学类型与RCC肺转移瘤患者预后之间的关系。
78例患者（93%）实现了完全切除。转移瘤切除术后5年总生存率为59.7%。在多变量分析中，发现三个因素是肺转移瘤切除术后总生存的独立有利预后因素[肿瘤大小<2 cm，风险比（HR）= 0.31，95%置信区间（CI）0.13 - 0.78，P = 0.012；透明细胞型，HR = 0.37，95% CI 0.16 - 0.83，P = 0.025；完全切除，HR = 0.27，95% CI 0.10 - 0.78，P = 0.015]。
本研究表明，除了完全切除和肿瘤大小<2 cm外，透明细胞型的组织学表现是一个显著的有利预后因素。肺转移瘤病变的组织学评估对于预测转移瘤切除术后的生存很重要。
