Almdalal Tarik, Sundqvist Pernilla, Harmenberg Ulrika, Hellström Mikael, Lindskog Magnus, Lindblad Per, Lundstam Svan, Ljungberg Börje
Department of Surgery and Urology, Eskilstuna Country Hospital, Eskilstuna, Sweden.
Department of Urology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
Eur Urol Open Sci. 2022 Apr 1;39:22-28. doi: 10.1016/j.euros.2022.03.005. eCollection 2022 May.
T1a renal cell carcinoma (RCC) is typically considered a curable disease, irrespective of the choice of local treatment modality.
To identify factors associated with the risk of local and distant recurrence, and overall survival (OS) in patients with primary nonmetastatic clinical T1a RCC.
A population-based nationwide register study of all 1935 patients with cT1a RCC, diagnosed during 2005-2012, identified through The National Swedish Kidney Cancer Register, was conducted.
Outcome variables were recurrence (local or distant) and OS. Possible explanatory variables included tumor size, RCC type, T stage, surgical technique, age, and gender. Associations with disease recurrence and OS were evaluated by multivariable regression and Cox multivariate analyses, respectively.
Among 1935 patients, 938 were treated with radical nephrectomy, 738 with partial nephrectomy, and 169 with ablative treatments, while 90 patients had no surgery. Seventy-eight (4%) patients were upstaged to pT3. Local or metastatic recurrences occurred in 145 (7.5%) patients, significantly more often after ablation (17.8%). The risk of recurrence was associated with tumor size, upstaging, and ablation. Larger tumor size, disease recurrence, and older age adversely affected OS, whereas partial nephrectomy and chromophobe RCC (chRCC) were associated with improved survival. Limitations include register design and a lack of comorbidity or performance status data.
Upstaging and recurrence occurred, respectively, in 4.0% and 7.5% of patients with nonmetastatic RCCs ≤4 cm. Tumor size upstaging and ablation were associated with the risk for recurrence, while tumor size and recurrence were associated with decreased OS. Patients with chRCC and partial nephrectomy had prolonged OS in a real-world setting.
We studied factors that may influence the risk of disease recurrence and overall survival, in a large nationwide patient cohort having nonmetastatic renal cell carcinoma ≤4 cm. Tumor size, tumor type, and treatment were associated with the risk of recurrence and overall death. Partial nephrectomy prolonged overall survival.
T1a期肾细胞癌（RCC）通常被认为是一种可治愈的疾病，无论选择何种局部治疗方式。
确定原发性非转移性临床T1a期RCC患者局部和远处复发风险以及总生存期（OS）的相关因素。
设计、设置和参与者：通过瑞典国家肾癌登记处进行了一项基于人群的全国性登记研究，纳入了2005年至2012年期间诊断的所有1935例cT1a期RCC患者。
结局变量为复发（局部或远处）和OS。可能的解释变量包括肿瘤大小、RCC类型、T分期、手术技术、年龄和性别。分别通过多变量回归和Cox多变量分析评估与疾病复发和OS的相关性。
1935例患者中，938例行根治性肾切除术，738例行部分肾切除术，169例行消融治疗，90例未接受手术。78例（4%）患者分期上调至pT3。145例（7.5%）患者发生局部或远处转移复发，消融治疗后复发更为常见（17.8%）。复发风险与肿瘤大小、分期上调和消融治疗相关。肿瘤体积较大、疾病复发和年龄较大对OS有不利影响，而部分肾切除术和嫌色性RCC（chRCC）与生存期改善相关。局限性包括登记设计以及缺乏合并症或体能状态数据。
≤4 cm的非转移性RCC患者中，分期上调和复发的发生率分别为4.0%和7.5%。肿瘤大小分期上调和消融治疗与复发风险相关，而肿瘤大小和复发与OS降低相关。在实际临床中，chRCC患者和接受部分肾切除术的患者OS延长。
我们在一个全国性的大型非转移性肾细胞癌≤4 cm患者队列中研究了可能影响疾病复发风险和总生存期的因素。肿瘤大小、肿瘤类型和治疗与复发风险及总体死亡相关。部分肾切除术可延长总生存期。
