Jhavar Sameer, Swanson Gregory, Pruszynski Jessica
Department of Radiation Oncology, Scott and White Medical Center, Temple, Texas, USA.
Department of Biostatistics, Scott and White Medical Center, Temple, Texas, USA.
Asia Pac J Clin Oncol. 2018 Jun;14(3):192-197. doi: 10.1111/ajco.12684. Epub 2017 May 10.
To identify risk factors for locoregional relapse after radical nephrectomy for renal cell carcinoma.
We retrospectively reviewed the charts of 259 patients who underwent radical nephrectomy for sporadic clinically localized unilateral renal cell carcinoma between 1998 and 2012. Relapse patterns (locoregional and/or distant) were identified. Relapse-free survival was calculated using Kaplan-Meier method. Factors associated with decreased relapse-free survival were identified using univariate and multivariate Cox proportional hazards regression model analysis. Locoregional relapse estimates were calculated for individual factors and combination of factors.
At a median follow-up of 68 months (interquartile range: 75 months), 24% patients relapsed. Of these, 54% had locoregional relapse. High-grade, positive margin, large tumor size and stage III/IV were associated with worse relapse-free survival on multivariate analysis. Locoregional relapse occurred among patients with tumor size >7-</ = 10 cm (22%), >10 cm (35%), stage III/IV (31%), grade III/IV (26%), renal vein invasion (22%), perinephric fat invasion (30%), </ = 7 cm plus grade III/IV (15%), >7 cm plus grade I/II (21%), >7 cm plus grade III/IV (48%), stage III/IV plus grade I/II (24%) and stage III/IV plus grade III/IV (45%).
We were able to discern risk factors (individual or in combination) associated with increased risk of locoregional relapse after radical nephrectomy for renal cell carcinoma. This could help distinguish patients who may benefit from adjuvant locoregionally directed therapy.
确定肾细胞癌根治性肾切除术后局部区域复发的危险因素。
我们回顾性分析了1998年至2012年间259例行根治性肾切除术治疗散发性临床局限性单侧肾细胞癌患者的病历。确定复发模式（局部区域和/或远处）。采用Kaplan-Meier法计算无复发生存率。使用单因素和多因素Cox比例风险回归模型分析确定与无复发生存率降低相关的因素。计算个体因素及因素组合的局部区域复发估计值。
中位随访68个月（四分位间距：75个月），24%的患者复发。其中，54%有局部区域复发。多因素分析显示，高级别、切缘阳性、肿瘤体积大及Ⅲ/Ⅳ期与无复发生存率较差相关。肿瘤大小>7-≤10 cm（22%）、>10 cm（35%）、Ⅲ/Ⅳ期（31%）、Ⅲ/Ⅳ级（26%）、肾静脉侵犯（22%）、肾周脂肪侵犯（30%）、≤7 cm加Ⅲ/Ⅳ级（15%）、>7 cm加Ⅰ/Ⅱ级（21%）、>7 cm加Ⅲ/Ⅳ级（48%）、Ⅲ/Ⅳ期加Ⅰ/Ⅱ级（24%）和Ⅲ/Ⅳ期加Ⅲ/Ⅳ级（45%）的患者发生局部区域复发。
我们能够识别出肾细胞癌根治性肾切除术后与局部区域复发风险增加相关的危险因素（单独或联合）。这有助于区分可能从辅助性局部区域定向治疗中获益的患者。
