Department of Urology, University Hospital Mainz, Mainz, Germany.
Hospital Clínic, University of Barcelona, Barcelona, Spain.
World J Urol. 2017 Dec;35(12):1891-1897. doi: 10.1007/s00345-017-2078-5. Epub 2017 Aug 23.
Because the prognostic impact of the clinical and pathological features on cancer-specific survival (CSS) and overall survival (OS) in patients with papillary renal cell carcinoma (papRCC) is still controversial, we want to assess the impact of clinicopathological features, including Fuhrman grade and age, on survival in surgically treated papRCC patients in a large multi-institutional series.
We established a comprehensive multi-institutional database of surgically treated papRCC patients. Histopathological data collected from 2189 patients with papRCC after radical nephrectomy or nephron-sparing surgery were pooled from 18 centres in Europe and North America. OS and CSS probabilities were estimated using the Kaplan-Meier method. Multivariable competing risks analyses were used to assess the impact of Fuhrman grade (FG1-FG4) and age groups (<50 years, 50-75 years, >75 years) on cancer-specific mortality (CSM).
CSS and OS rates for patients were 89 and 81% at 3 years, 86 and 75% at 5 years and 78 and 41% at 10 years after surgery, respectively. CSM differed significantly between FG 3 (hazard ratio [HR] 4.22, 95% confidence interval [CI] 2.17-8.22; p < 0.001) and FG 4 (HR 8.93, 95% CI 4.25-18.79; p < 0.001) in comparison to FG 1. CSM was significantly worse in patients aged >75 (HR 2.85, 95% CI 2.06-3.95; p < 0.001) compared to <50 years.
FG is a strong prognostic factor for CSS in papRCC patients. In addition, patients older than 75 have worse CSM than patients younger than 50 years. These findings should be considered for clinical decision making.
由于临床和病理特征对乳头状肾细胞癌（papRCC）患者癌症特异性生存（CSS）和总生存（OS）的预后影响仍存在争议，我们希望在一个大型多机构系列中评估包括 Fuhrman 分级和年龄在内的临床病理特征对接受手术治疗的 papRCC 患者生存的影响。
我们建立了一个综合的多机构接受手术治疗的 papRCC 患者数据库。从欧洲和北美的 18 个中心收集了 2189 例接受根治性肾切除术或肾部分切除术的 papRCC 患者的组织病理学数据。使用 Kaplan-Meier 方法估计 OS 和 CSS 概率。使用多变量竞争风险分析评估 Fuhrman 分级（FG1-FG4）和年龄组（<50 岁、50-75 岁、>75 岁）对癌症特异性死亡率（CSM）的影响。
手术后 3 年、5 年和 10 年，患者的 CSS 和 OS 率分别为 89%和 81%、86%和 75%以及 78%和 41%。与 FG1 相比，FG3（危险比[HR]4.22，95%置信区间[CI]2.17-8.22；p<0.001）和 FG4（HR8.93，95%CI4.25-18.79；p<0.001）的 CSM 差异有统计学意义。与<50 岁的患者相比，年龄>75 岁的患者的 CSM 显著更差（HR2.85，95%CI2.06-3.95；p<0.001）。
FG 是 papRCC 患者 CSS 的一个强有力的预后因素。此外，年龄大于 75 岁的患者比年龄小于 50 岁的患者 CSM 更差。这些发现应在临床决策中考虑。
