Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Department of Urology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
Cancer. 2018 Oct 15;124(20):4023-4031. doi: 10.1002/cncr.31661. Epub 2018 Oct 1.
Lymph node (LN) metastases are associated with poor outcomes for patients with renal cell carcinoma (RCC). This study compared the survival outcomes of patients with stage III, node-positive disease (pT N M ) and patients with stage III, node-negative disease (pT N M ).
A database of 4652 patients with RCC of any histological subtype treated with surgery at The University of Texas MD Anderson Cancer Center from 1993 to 2012 was retrospectively assessed. A total of 115 patients with pT N M disease, 274 patients with pT N M disease, and 523 patients with pT N M disease were included. Overall survival (OS) and cancer-specific survival (CSS) were estimated and compared between each cohort.
Median OS and CSS times were significantly better for pT N M patients than pT N M patients (OS, 10.2 vs 2.4 years, P < .0001; CSS, not reached vs 2.8 years, P < .0001). Similar median OS and CSS times were noted for pT N M and pT N M patients (OS, 2.4 vs 2.4 years; P = .62; CSS, 2.8 vs 2.4 years; P = .10). In a multivariate analysis, tumor grade (hazard ratio [HR] for OS, 2.47; P < .0001; HR for CSS, 2.99; P < .0001) and pathologic LN involvement (HR for OS, 2.44; P < .0001; HR for CSS, 2.85; P < .0001) were associated with worse OS and CSS.
Among RCC patients classified with stage III disease, those with pT N M disease had significantly worse survival than those with pT N M disease. OS and CSS were similar for patients with pT N M disease and patients with pT N M disease (stage IV). If validated, these findings suggest that RCC patients with nodal disease should be reclassified as having stage IV disease.
淋巴结（LN）转移与肾细胞癌（RCC）患者的不良预后相关。本研究比较了 III 期、阳性淋巴结疾病（pT N M ）患者和 III 期、阴性淋巴结疾病（pT N M ）患者的生存结局。
回顾性评估了 1993 年至 2012 年在德克萨斯大学 MD 安德森癌症中心接受手术治疗的任何组织学亚型的 4652 例 RCC 患者的数据库。共纳入 115 例 pT N M 疾病患者、274 例 pT N M 疾病患者和 523 例 pT N M 疾病患者。估计并比较了每个队列的总生存期（OS）和癌症特异性生存期（CSS）。
与 pT N M 患者相比，pT N M 患者的中位 OS 和 CSS 时间明显更长（OS，10.2 比 2.4 年，P<0.0001；CSS，未达到比 2.8 年，P<0.0001）。pT N M 和 pT N M 患者的中位 OS 和 CSS 时间相似（OS，2.4 比 2.4 年；P=0.62；CSS，2.8 比 2.4 年；P=0.10）。在多变量分析中，肿瘤分级（OS 的危险比 [HR]，2.47；P<0.0001；CSS 的 HR，2.99；P<0.0001）和病理淋巴结受累（OS 的 HR，2.44；P<0.0001；CSS 的 HR，2.85；P<0.0001）与较差的 OS 和 CSS 相关。
在 III 期疾病分类的 RCC 患者中，pT N M 疾病患者的生存明显差于 pT N M 疾病患者。pT N M 疾病患者和 pT N M 疾病患者（IV 期）的 OS 和 CSS 相似。如果得到验证，这些发现表明应将淋巴结疾病的 RCC 患者重新归类为 IV 期疾病。
