乳头状 I 型与 II 型肾细胞癌的临床、病理和长期肿瘤学结果。
Clinical, pathological and long-term oncologic outcomes of papillary type I vs. type II renal cell carcinoma.
机构信息
Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy.
出版信息
Urol Oncol. 2022 Aug;40(8):384.e15-384.e21. doi: 10.1016/j.urolonc.2022.05.012. Epub 2022 May 31.
BACKGROUND
Despite papillary renal cell carcinoma (pRCC) subtype represents the second most common histological renal tumor, controversial findings have been shown regarding its prognosis. Thus, we investigated the natural history of patients harbouring pRCC, focusing on its clinicopathological characteristics and long-term oncologic outcomes among pRCC subtypes.
MATERIALS AND METHODS
We identified 447 patients treated with either partial (PN) or radical nephrectomy (RN) for pRCC at a single tertiary centre, between 1994 and 2019. First, we explored differences in baseline and clinicopathological characteristics. Second, Kaplan-Meier plots investigated progression-free survival (PFS) and cancer-specific survival (CSS) differences among pRCC subtypes. Third, multivariable Cox-regression analyses (MVA) were used to assess predictors of clinical progression (CP) and cancer-specific mortality (CSM).
RESULTS
Overall, 120 (27%) patients had symptoms at time of diagnosis. 263 (58.8%) vs. 184 (41.2%) patients underwent PN vs. RN. At histopathological evaluation, 243 (54.4%) harboured pRCC type I vs. 204 (45.6%) type II. pRCC type II more frequently showed higher tumor grade, tumor necrosis or lymphovascular invasion (all P<0.001). After a median follow-up of 51 months, 2.5% and 11% of patients had local relapse and CP, respectively. Kaplan-Meier plots revealed 93 vs. 83% 5-year PFS (P<0.001) and 96 vs. 89% 5-year CSS (P=0.01) for non-metastatic pRCC type I vs. II, respectively. At MVA, pRCC type II predicted higher risk of CP (Hazard ratio [HR]: 3.03, 95%CI 1.42-6.44; P=0.01), as well as of CSM (HR: 2.60, 95%CI 1.05-6.29; P=0.02), relative to pRCC type I.
CONCLUSIONS
PRCC type II harbour more unfavorable tumor characteristics, such as higher tumor grade, more frequent tumor necrosis or lymphvascular invasion, which translates into worse long-term oncologic outcomes, compared with pRCC type I. Thus, patients harbouring pRCC type II may benefit from stricter follow-up, as well as earlier risk-based adjuvant therapies, based on potential worse oncologic outcomes in this patient population.
背景
尽管乳头状肾细胞癌（pRCC）亚型是第二常见的肾组织学肿瘤，但关于其预后仍存在争议。因此，我们研究了携带 pRCC 的患者的自然病史，重点关注其在 pRCC 亚型中的临床病理特征和长期肿瘤学结局。
材料和方法
我们在一家三级中心确定了 1994 年至 2019 年间接受部分（PN）或根治性肾切除术（RN）治疗的 447 名 pRCC 患者。首先，我们探讨了基线和临床病理特征的差异。其次，通过 Kaplan-Meier 图研究了 pRCC 亚型之间无进展生存期（PFS）和癌症特异性生存期（CSS）的差异。第三，使用多变量 Cox 回归分析（MVA）评估临床进展（CP）和癌症特异性死亡率（CSM）的预测因素。
结果
总体而言，120 名（27%）患者在诊断时出现症状。263 名（58.8%）与 184 名（41.2%）患者接受 PN 与 RN。在组织病理学评估中，243 名（54.4%）携带 pRCC 型 I 与 204 名（45.6%）携带 pRCC 型 II。pRCC 型 II 更频繁地表现出更高的肿瘤分级、肿瘤坏死或血管淋巴管侵犯（均 P<0.001）。在中位随访 51 个月后，2.5%和 11%的患者分别出现局部复发和 CP。Kaplan-Meier 图显示，非转移性 pRCC 型 I 与 II 的 5 年 PFS 分别为 93%和 83%（P<0.001），5 年 CSS 分别为 96%和 89%（P=0.01）。在 MVA 中，pRCC 型 II 预测 CP（风险比 [HR]：3.03，95%CI 1.42-6.44；P=0.01）和 CSM（HR：2.60，95%CI 1.05-6.29；P=0.02）的风险均高于 pRCC 型 I。
结论
与 pRCC 型 I 相比，pRCC 型 II 具有更多不良的肿瘤特征，如更高的肿瘤分级、更频繁的肿瘤坏死或血管淋巴管侵犯，这转化为更差的长期肿瘤学结局。因此，携带 pRCC 型 II 的患者可能受益于更严格的随访以及更早的基于风险的辅助治疗，因为这一患者群体的肿瘤学结局可能更差。
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