Tiwari Priya, Kumar Lalit, Thulkar Sanjay, Singh Geetika, Malik Prabhat, Seth Amlesh
Department of Medical Oncology, New Delhi-29, India.
DR. B.R.A. Institute Rotary Cancer Hospital, New Delhi-29, India.
Asian Pac J Cancer Prev. 2018 Apr 25;19(4):891-895. doi: 10.22034/APJCP.2018.19.4.891.
Background: Recurrence of renal cell cancer (RCC) affects approximately one-third of patients after curative nephrectomy. However, studies from the Indian subcontinent have been scarce. We here ddetermine relapse rates and patterns in an Indian cohort. Methods: This study included all patients with RCC who underwent nephrectomy from 2004 to 2013 at our centre. Recurrence-free survival (RFS) was calculated from the date of surgery to date of recurrence or death. The Cox regression model was applied to identify significant prognostic factors. Results: Overall a total of 292 patients were included. Median age was 50 years (range 19-84 years), with a male:female ratio of 3:1. Radical and partial nephrectomy were performed for 276 (94.5%) and 16 (5.5%) patients, respectively. Clear cell was most common histological subtype (71.2%) and T1, T2, T3 and T4 stages accounted for 89 (30.5%), 86 (29.5%), 105 (36%) and 12 (4.1%) patients, respectively. One hundred and thirty-six patients (46.6%) demonstrated recurrence. Eighty-six (63.2%) relapsed at distant sites, 14 (10.3%) and at locoregional sites whereas 36(26.5%) had both distant and locoregional recurrence. Median time to recurrence was 18 months. Approximately 17.7% of cases had disease reappearance after five years. Factors predicting shorter RFS on multivariate analysis were patient reported weight loss (p=0.004), Fuhrman grade 3 or 4 (p<0.0001), presence of necrosis (p<0.0001) and higher tumour stage (p=0.005). Conclusion: Compared to previous studies, our patients had higher rates of recurrence in general and locoregional recurrence in particular. However, except for weight loss, other predictive factors remain similar. Finding weight loss as the marker of recurrence emphasises the importance of the simple task of history taking.
肾细胞癌（RCC）复发影响了约三分之一接受根治性肾切除术的患者。然而，来自印度次大陆的相关研究较少。我们在此确定一个印度队列中的复发率及复发模式。方法：本研究纳入了2004年至2013年在我们中心接受肾切除术的所有RCC患者。无复发生存期（RFS）从手术日期计算至复发或死亡日期。应用Cox回归模型来确定显著的预后因素。结果：总共纳入了292例患者。中位年龄为50岁（范围19 - 84岁），男女比例为3:1。分别对276例（94.5%）和16例（5.5%）患者进行了根治性肾切除术和部分肾切除术。透明细胞是最常见的组织学亚型（71.2%），T1、T2、T3和T4期分别占89例（30.5%）、86例（29.5%）、105例（36%）和12例（4.1%）患者。136例患者（46.6%）出现复发。86例（63.2%）在远处复发，14例（10.3%）在局部区域复发，而36例（26.5%）既有远处复发又有局部区域复发。复发的中位时间为18个月。约17.7%的病例在5年后疾病再次出现。多因素分析中预测RFS较短的因素包括患者自述体重减轻（p = 0.004）、Fuhrman分级3级或4级（p < 0.0001）、存在坏死（p < 0.0001）以及较高的肿瘤分期（p = 0.005）。结论：与先前的研究相比，我们的患者总体复发率较高，尤其是局部区域复发率。然而，除体重减轻外，其他预测因素仍然相似。发现体重减轻作为复发标志物强调了病史采集这项简单任务的重要性。
