Guo Pengju, Wang Yongxing, Han Yili, Wei Dechao, Zhao Jiahui, Li Mingchuan, Jiang Yongguang, Luo Yong
Department of Urology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Front Oncol. 2021 Jun 3;11:678459. doi: 10.3389/fonc.2021.678459. eCollection 2021.
To identify the differences in oncological outcomes for patients with different pT3a renal tumor invasion patterns and pathological features.
The protocol of this study was registered on PROSPERO (CRD42021234475). Relevant studies were identified by searching the PubMed, Cochrane library, Embase, and Web of Science databases. Cancer-specific survival (CSS) was selected as the endpoint. Pooled hazard ratio (HR) and 95% confidence interval (CI) extracted from multivariate Cox models were evaluated to identify the hazard association.
A total of 22 studies, which enrolled 12384 patients were included for quantitative synthesis. Sinus fat invasion (SFI) + perinephric fat invasion (PFI) was associated with inferior CSS compared to SFI only (p = 0.02). Comparable CSS was observed between SFI and PFI (p = 0.57). SFI ± PFI showed inferior CSS compared to PFI only (p = 0.0002). The presence of pelvicalyceal system invasion significantly increased the risk of cancer-specific mortality (p = 0.0005). Renal vein invasion (RVI) indicated poor oncological outcomes in terms of CSS (p = 0.002). The concomitant RVI and fat invasion (FI) significantly increased the risk of deterioration of CSS compared to RVI or FI (p < 0.0001). Multiple invasion patterns translated into a significantly decreased CSS (p < 0.0001). Aggressive tumor behavior, including lymph node involvement (p = 0.006), distant metastases (p < 0.00001), sarcomatoid differentiation (p < 0.0001), necrosis (p < 0.0001), Fuhrman grade III or IV (p < 0.0001), positive margin (p < 0.0001), and tumor size >7cm (p < 0.0001) were the predictors of inferior CSS. The lymphovascular invasion (p = 0.67) was indolent in terms of CSS.
This study confirmed the heterogenicity of pT3a renal tumors. Multiple invasion patterns could translate into a significantly decreased CSS, and SFI should not be merged in the SFI + PFI group. The presence of PSI or RVI could significantly increase the risk of cancer-specific mortality. Lymph node involvement, distant metastases, sarcomatoid differentiation, necrosis, high Fuhrman grade, positive margin, and size >7cm were the predictors of inferior CSS. A precise-risk grade of CSS for different invasion patterns including comprehensive combinations may be useful for the further refinements of the TNM system.
The current study was registered on PROSPERO, and the registration numbers is CRD42021234475.
确定不同pT3a肾肿瘤浸润模式和病理特征患者的肿瘤学结局差异。
本研究方案已在国际前瞻性系统评价注册库（PROSPERO，注册号：CRD42021234475）登记。通过检索PubMed、Cochrane图书馆、Embase和Web of Science数据库来识别相关研究。选择癌症特异性生存（CSS）作为终点。评估从多变量Cox模型中提取的合并风险比（HR）和95%置信区间（CI），以确定风险关联。
共纳入22项研究，涉及12384例患者进行定量综合分析。与仅存在窦周脂肪浸润（SFI）相比，窦周脂肪浸润（SFI）+肾周脂肪浸润（PFI）与较差的CSS相关（p = 0.02）。SFI和PFI之间观察到相当的CSS（p = 0.57）。与仅存在PFI相比，SFI±PFI显示出较差的CSS（p = 0.0002）。肾盂肾盏系统浸润的存在显著增加了癌症特异性死亡风险（p = 0.0005）。肾静脉浸润（RVI）在CSS方面提示肿瘤学结局较差（p = 0.002）。与RVI或脂肪浸润（FI）相比，RVI和FI同时存在显著增加了CSS恶化的风险（p < 0.0001）。多种浸润模式转化为显著降低的CSS（p < 0.0001）。侵袭性肿瘤行为，包括淋巴结受累（p = 0.006）、远处转移（p < 0.00001）、肉瘤样分化（p < 0.0001）、坏死（p < 0.0001）、Fuhrman分级III或IV级（p < 0.0001）、切缘阳性（p < 0.0001）和肿瘤大小>7cm（p < 0.0001）是CSS较差的预测因素。就CSS而言，脉管浸润（p = 0.67）呈惰性。
本研究证实了pT3a肾肿瘤的异质性。多种浸润模式可转化为显著降低的CSS，且SFI不应合并到SFI + PFI组中。肾盂肾盏系统浸润或RVI的存在可显著增加癌症特异性死亡风险。淋巴结受累、远处转移、肉瘤样分化、坏死、高Fuhrman分级、切缘阳性和大小>7cm是CSS较差的预测因素。针对不同浸润模式（包括综合组合）的精确CSS风险分级可能有助于进一步完善TNM系统。
本研究已在PROSPERO注册，注册号为CRD42021234475。
