Nocera Luigi, Collà Ruvolo Claudia, Stolzenbach Lara F, Wenzel Mike, Tian Zhe, Larcher Alessandro, Capitanio Umberto, Mirone Vincenzo, Tilki Derya, Chun Felix K H, Kapoor Anil, Shariat Shahrokh F, Saad Fred, Montorsi Francesco, Briganti Alberto, Karakiewicz Pierre I
Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Canada; Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Canada; Department of Urology, University of Naples Federico II, Naples, Italy.
Eur Urol Focus. 2022 Jan;8(1):182-190. doi: 10.1016/j.euf.2021.02.009. Epub 2021 Feb 27.
For patients with nonmetastatic renal cell carcinoma (nmRCC) treated with nephrectomy, prediction of cancer-specific mortality (CSM) by T stage and substage has not been validated for the separate histological subtypes.
To investigate the ability of pathological T stage and substage to predict CSM for patients with clear-cell, papillary, or chromophobe nmRCC treated with nephrectomy.
DESIGN, SETTING, AND PARTICIPANTS: Using the SEER database for 2004-2016, we identified 87 149 patients with T1-4 N0/X M0 nmRCC treated with nephrectomy for the clear-cell (65 715; 75.4%), papillary (14 587; 16.7%), or chromophobe (6847; 7.9%) histological subtype.
Kaplan-Meier plots and Cox regression models were used to estimate CSM.
For all three histological subtypes, patients with T1a-T3a disease exhibited more favorable CSM than patients with T3b-T4 RCC. For clear-cell RCC, there were clinically meaningful and statistically significant differences for virtually all intergroup comparisons among T1a-T3a stages. For papillary T1a-T3a RCC, clinically meaningful differences disappeared, although the statistical significance remained. For chromophobe T1a-T3a RCC, no clinically meaningful or statistically significant differences were observed. For all three histological subtypes, patients with T3b-T4 RCC exhibited virtually uniformly unfavorable CSM, with no clinically meaningful intergroup CSM differences.
The use of T stage and substage for stratification of patients with nmRCC treated with nephrectomy revealed differences in CSM among T1a-T3a cases, but not T3b-T4. The magnitude of the CSM difference was greatest for clear-cell, intermediate for papillary, and marginal for chromophobe RCC.
For patients with kidney cancer, the stage of their disease assessed after surgery on the affected kidney can predict how likely they are to die from their cancer. This prediction varies for different subtypes of kidney cancer.
对于接受肾切除术治疗的非转移性肾细胞癌（nmRCC）患者，T分期和亚分期对癌症特异性死亡率（CSM）的预测在不同组织学亚型中尚未得到验证。
探讨病理T分期和亚分期对接受肾切除术治疗的透明细胞、乳头状或嫌色细胞nmRCC患者CSM的预测能力。
设计、设置和参与者：利用2004 - 2016年的监测、流行病学和最终结果（SEER）数据库，我们确定了87149例接受肾切除术治疗的T1 - 4 N0/X M0 nmRCC患者，其组织学亚型为透明细胞型（65715例；75.4%）、乳头状型（14587例；16.7%）或嫌色细胞型（6847例；7.9%）。
采用Kaplan - Meier曲线和Cox回归模型来估计CSM。
对于所有三种组织学亚型，T1a - T3a期疾病患者的CSM比T3b - T4期肾细胞癌患者更有利。对于透明细胞肾细胞癌，T1a - T3a期之间几乎所有组间比较都存在临床意义和统计学意义上的差异。对于乳头状T1a - T3a肾细胞癌，临床意义上的差异消失，尽管统计学意义仍然存在。对于嫌色细胞T1a - T3a肾细胞癌，未观察到临床意义或统计学意义上的差异。对于所有三种组织学亚型，T3b - T4期肾细胞癌患者的CSM几乎都同样不利，组间CSM无临床意义上的差异。
使用T分期和亚分期对接受肾切除术治疗的nmRCC患者进行分层，发现T1a - T3a病例之间CSM存在差异，但T3b - T4期无差异。CSM差异的程度在透明细胞型中最大，乳头状型居中，嫌色细胞型最小。
对于肾癌患者，患侧肾脏手术后评估的疾病分期可以预测他们死于癌症的可能性。这种预测因肾癌的不同亚型而异。
