Division of Surgery and Interventional Science, University College London, London, UK.
Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, Royal Free Hospital, Pond street, London, NW3 2QG, UK.
World J Urol. 2021 Oct;39(10):3823-3831. doi: 10.1007/s00345-021-03683-9. Epub 2021 Apr 13.
Currently there are no specific guidelines for the post-operative follow-up of chromophobe renal cell carcinoma (chRCC). We aimed to evaluate the pattern, location and timing of recurrence after surgery for non-metastatic chRCC and establish predictors of recurrence and cancer-specific death.
Retrospective analysis of consecutive surgically treated non-metastatic chRCC cases from the Royal Free London NHS Foundation Trust (UK, 2015-2019) and the international collaborative database RECUR (15 institutes, 2006-2011). Kaplan-Meier curves were plotted. The association between variables of interest and outcomes were analysed using univariate and multivariate Cox proportional hazards regression models with shared frailty for data source.
295 patients were identified. Median follow-up was 58 months. The five and ten-year recurrence-free survival rates were 94.3% and 89.2%. Seventeen patients (5.7%) developed recurrent disease, 13 (76.5%) with distant metastases. 54% of metastatic disease diagnoses involved a single organ, most commonly the bone. Early recurrence (< 24 months) was observed in 8 cases, all staged ≥ pT2b. 30 deaths occurred, of which 11 were attributed to chRCC. Sarcomatoid differentiation was rare (n = 4) but associated with recurrence and cancer-specific death on univariate analysis. On multivariate analysis, UICC/AJCC T-stage ≥ pT2b, presence of coagulative necrosis, and positive surgical margins were predictors of recurrence and cancer-specific death.
Recurrence and death after surgically resected chRCC are rare. For completely excised lesions ≤ pT2a without coagulative necrosis or sarcomatoid features, prognosis is excellent. These patients should be reassured and follow-up intensity curtailed.
目前，对于肾嫌色细胞癌（chRCC）患者的术后随访并无具体指南。本研究旨在评估非转移性 chRCC 患者手术后的复发模式、部位和时间，并确定复发和癌症特异性死亡的预测因素。
回顾性分析了 2015 年至 2019 年期间，英国皇家自由伦敦国民保健服务信托基金会（Royal Free London NHS Foundation Trust）连续手术治疗的非转移性 chRCC 病例，以及国际合作数据库 RECUR（15 个研究所，2006 年至 2011 年）中的病例。绘制 Kaplan-Meier 曲线。使用单变量和多变量 Cox 比例风险回归模型，对感兴趣的变量与结局之间的关系进行分析，并对数据源进行共享脆弱性校正。
共纳入 295 例患者。中位随访时间为 58 个月。5 年和 10 年无复发生存率分别为 94.3%和 89.2%。17 例患者（5.7%）出现复发性疾病，其中 13 例（76.5%）为远处转移。54%的转移性疾病诊断涉及单个器官，最常见的是骨骼。8 例患者（54%）早期复发（<24 个月），且均为 pT2b 及以上分期。30 例患者死亡，其中 11 例归因于 chRCC。肉瘤样分化罕见（n=4），但在单变量分析中与复发和癌症特异性死亡相关。多变量分析显示，UICC/AJCC T 分期≥pT2b、存在凝固性坏死和阳性切缘是复发和癌症特异性死亡的预测因素。
手术切除后 chRCC 的复发和死亡较为罕见。对于完全切除的≤pT2a 病变，且无凝固性坏死或肉瘤样特征的患者，预后极佳。应对这些患者进行安抚，并减少随访强度。
