Department of Urology and Andrology, Kansai Medical University, 2-3-1 Shin-machi, Hirakata, Osaka, 573-1191, Japan.
Department of Pathology and Laboratory Medicine, Kansai Medical University, 2-3-1 Shin-machi, Hirakata, Osaka, 573-1191, Japan.
Int J Clin Oncol. 2020 Mar;25(3):464-471. doi: 10.1007/s10147-019-01543-6. Epub 2019 Sep 17.
This study evaluated the clinical significance of pathological factors associated with T3a upstaging according to the American Joint Committee on Cancer/Union for International Cancer Control 8th edition TNM-staging system in patients with clinical T1 renal cell carcinoma undergoing definitive surgery.
We retrospectively investigated 418 patients with renal cell carcinoma who underwent partial or radical nephrectomy at our institution between 2006 and 2016. Surgical specimens were grossly and microscopically re-reviewed with respect to extrarenal extension patterns by two urological pathologists. Kaplan-Meier analysis and Cox regression were used to determine the impact of the factors associated with pathological stage T3a on recurrence-free survival. Harrell's c-index was used to compare the prognostic accuracy of the current and previous staging systems.
Overall, the 5-year recurrence-free survival was 94.5% (median follow-up duration, 60.8 months). Of 418 patients, 46 (11.0%) were upstaged to pathological stage T3a, including 12/267 (4.5%) and 34/151 (22.5%) in the partial and radical nephrectomy groups, respectively. Among these upstaged patients, partial nephrectomy was significantly associated with a higher recurrence rate than radical nephrectomy (5-year recurrence-free survival: 48.9 vs. 83.9%, P = 0.0172). Although perinephric fat invasion had the highest c-index in all patients (0.580-0.679), microscopic segmental renal vein invasion was a significant predictor of recurrence in patients undergoing partial nephrectomy (c-index, 0.60).
Assessing microscopic segmental renal vein invasion, which has been included in the current staging system recently, is essential to accurately predict the oncological outcome in the era of partial nephrectomy for clinical T1 renal cell carcinoma.
本研究评估了根据美国癌症联合委员会/国际癌症控制联盟第 8 版 TNM 分期系统，在接受根治性手术的临床 T1 肾细胞癌患者中，与 T3a 分期升级相关的病理因素的临床意义。
我们回顾性调查了 2006 年至 2016 年期间在我院接受部分或根治性肾切除术的 418 例肾细胞癌患者。两名泌尿科病理学家对手术标本进行了大体和显微镜下重新检查，以评估肾外延伸模式。Kaplan-Meier 分析和 Cox 回归用于确定与病理 T3a 期相关的因素对无复发生存的影响。Harrell's c 指数用于比较当前和以前分期系统的预后准确性。
总体而言，5 年无复发生存率为 94.5%（中位随访时间为 60.8 个月）。在 418 例患者中，46 例（11.0%）被升级为病理 T3a 期，其中 267 例中的 12 例（4.5%）和 151 例中的 34 例（22.5%）分别为部分和根治性肾切除术组。在这些升级的患者中，与根治性肾切除术相比，部分肾切除术与更高的复发率显著相关（5 年无复发生存率：48.9%比 83.9%，P=0.0172）。尽管在所有患者中，肾周脂肪侵犯的 c 指数最高（0.580-0.679），但显微镜下节段性肾静脉侵犯是部分肾切除术患者复发的显著预测因素（c 指数，0.60）。
评估最近已纳入当前分期系统的显微镜下节段性肾静脉侵犯对于准确预测部分肾切除术治疗临床 T1 肾细胞癌的肿瘤学结果至关重要。
