Clark Kellan F, Risendal Matthew, Hill Sharon, Deem Samuel
Urologic Surgery, Charleston Area Medical Center, Charleston, West Virginia, USA.
Can J Urol. 2019 Apr;26(2):9715-9719.
The TNM staging system is used globally as the standard for interpreting the extent of cancer. Currently, T3a renal cell carcinoma is classified as tumor extending into the perinephric fat or renal vein. Prognostic outcomes may vary among renal cell carcinomas with renal vein involvement (RVI) versus those with perinephric fat involvement (PFI).
We reviewed the medical records of all patients who underwent radical or partial nephrectomy at our institution by a single group of urologists between 2000 and 2014. After identifying those patients with T3a renal cell carcinoma, we further analyzed their prognostic features. Overall and disease-free survival using Kaplan-Meier analysis with log rank comparison was performed among patients with renal vein involvement and PFI. Gender, smoking status, age at diagnosis, body mass index, tumor grade, tumor size, and tumor histology were also analyzed.
Of 139 patients with T3a renal cell carcinoma, 42 patients were found to have RVI, leaving 97 patients with PFI. Mean follow up was 52.1 months (0.3-183.4) versus 28.8 months (0.3-98.0) for patients with PFI and RVI, respectively. Overall survival (p < 0.048) and disease-free survival (p < 0.049) were significantly lower for patients with RVI.
In our study, patients with T3a renal cell carcinoma that have RVI as opposed to PFI have lower overall and disease-free survival. These findings suggest that patient with T3a renal cell carcinoma with RVI should be monitored more closely than their counterparts with only PFI.
TNM分期系统在全球范围内被用作解释癌症范围的标准。目前，T3a期肾细胞癌被归类为肿瘤侵犯肾周脂肪或肾静脉。肾静脉受累（RVI）的肾细胞癌与肾周脂肪受累（PFI）的肾细胞癌的预后结果可能有所不同。
我们回顾了2000年至2014年间在我们机构由一组泌尿外科医生进行根治性或部分肾切除术的所有患者的病历。在确定那些患有T3a期肾细胞癌的患者后，我们进一步分析了他们的预后特征。对肾静脉受累和PFI的患者进行了Kaplan-Meier分析和对数秩比较，以评估总生存期和无病生存期。还分析了性别、吸烟状况、诊断时年龄、体重指数、肿瘤分级、肿瘤大小和肿瘤组织学。
在139例T3a期肾细胞癌患者中，发现42例有RVI，97例有PFI。PFI患者的平均随访时间为52.1个月（0.3 - 183.4个月），RVI患者为28.8个月（0.3 - 98.0个月）。RVI患者的总生存期（p < 0.048）和无病生存期（p < 0.049）显著较低。
在我们的研究中，与PFI相比，患有RVI的T3a期肾细胞癌患者的总生存期和无病生存期较低。这些发现表明，与仅有PFI的患者相比，患有RVI的T3a期肾细胞癌患者应接受更密切的监测。
