Department of Urology, University Medical Center, Mainz, Germany.
Urology and Nephrology Center, Mansoura, Egypt.
Int J Urol. 2019 Mar;26(3):385-390. doi: 10.1111/iju.13882. Epub 2018 Dec 26.
To determine the long-term oncological outcome of organ-confined (<pT3) renal cell carcinoma.
We identified 889 patients with complete long-term follow-up data, who had been surgically treated for renal cell carcinoma (<T3) at our institution between 1976 and 2009. Kaplan-Meier analysis was used to assess the incidence and time interval of recurrence defined as local recurrences or metastases. We further compared patients who had tumor progression before or after 60 months.
After a median follow-up period of 74.33 months (range 3-329 months), 44 patients (4.9%) had disease recurrence. A total of 38.6% of the recurrences occurred after 60 months; 76.2% of patients had distant metastases and 23.8% of patients had local recurrences. In patients with low-grade (G1) and low-stage (pT1a) tumors, there was a trend to develop recurrence or metastases after longer intervals. Patients with lung metastasis and patients with multiple metastatic locations developed these metastases earlier than patients with bone metastasis. The risk of dying of other causes correlated with age, but the time interval to metastases did not.
Current guidelines recommend a follow-up period of 60 months after surgical treatment of organ-confined renal cell carcinoma. Our data shows that one-third of recurrences of <pT3 renal cell carcinoma occur after 60 months. According to our oncological analysis, we suggest an age-adjusted strategy of follow-up balancing the risk of tumor recurrence and the life expectancy of the patient.
确定局限性（<pT3）肾细胞癌的长期肿瘤学结果。
我们确定了 889 名具有完整长期随访数据的患者，他们在 1976 年至 2009 年期间在我们机构接受了肾细胞癌（<T3）的手术治疗。Kaplan-Meier 分析用于评估复发的发生率和时间间隔，定义为局部复发或转移。我们进一步比较了在 60 个月之前或之后发生肿瘤进展的患者。
在中位随访期 74.33 个月（范围 3-329 个月）后，44 名患者（4.9%）出现疾病复发。共有 38.6%的复发发生在 60 个月之后；76.2%的患者有远处转移，23.8%的患者有局部复发。在低分级（G1）和低分期（pT1a）肿瘤患者中，存在较长时间间隔后发生复发或转移的趋势。有肺转移的患者和有多个转移部位的患者比有骨转移的患者更早发生这些转移。因其他原因死亡的风险与年龄相关，但转移的时间间隔无关。
当前指南建议在手术治疗局限性肾细胞癌后进行 60 个月的随访。我们的数据显示，三分之一的<pT3 肾细胞癌复发发生在 60 个月之后。根据我们的肿瘤学分析，我们建议采用基于年龄调整的随访策略，平衡肿瘤复发的风险和患者的预期寿命。
