肿瘤轮廓不规则对 T1bN0M0 期肾细胞癌手术策略的预后价值：一项多机构研究。
Prognostic value of tumour contour irregularity on surgical strategies for T1bN0M0 renal cell carcinoma: A multi-institutional study.
机构信息
Department of Urology, Xuhui Hospital, Fudan University, 966th Huaihai Middle Rd, Xuhui District, Shanghai, China; Department of Urology, Zhongshan Hospital, Fudan University, 180th Fengling Rd, Xuhui District, Shanghai, China.
Department of Urology, Zhongshan Hospital, Fudan University, 180th Fengling Rd, Xuhui District, Shanghai, China.
出版信息
Eur J Radiol. 2023 Feb;159:110665. doi: 10.1016/j.ejrad.2022.110665. Epub 2022 Dec 21.
PURPOSE
To determine the prognostic value of tumour contour irregularity degree (CID) in surgical strategy options for T1bN0M0 renal cell carcinoma (RCC).
MATERIALS AND METHODS
We performed a retrospective multi-institutional review of 489 patients with T1bN0M0 RCC treated between January 2009 and June 2019. Cox regression and Kaplan-Meier analyses were performed to analyse the impact of CID on disease-free survival (DFS).
RESULTS
The median follow-up time was 55 months (interquartile range, 40-81 months) for 55 (11.2 %) patients with metastasis or recurrence. Logistic analysis indicated that CID was associated with World Health Organization/International Society of Urological Pathology (WHO/ISUP) grades III-IV (odds ratio, 1.015; 95 % confidence interval [CI], 1.008-1.023; p < 0.001). After being classified into high CID (≥50 %) and low CID (<50 %) groups, those with a high CID showed a significantly higher ratio of WHO/IUSP grades III-IV (74/277 [26.7 %] vs 25/212 [11.8 %]) and shorter DFS than the low CID group (p < 0.001). Multivariable Cox regression showed that partial nephrectomy (PN; hazard ratio [HR], 1.889; 95 % CI, 1.020-3.499; p = 0.043), high CID (HR, 6.685; 95 % CI, 2.776-16.100; p < 0.001), and WHO/ISUP grade III-IV (HR, 1.950; 95 % CI, 1.100-3.458; p = 0.022) were independent prognostic factors for DFS. The Kaplan-Meier plot showed that PN had a DFS rate comparable to that of radical nephrectomy (RN; p = 0.994). In the low CID group, patients who underwent PN showed comparable DFS to those who underwent RN (p = 0.903). Furthermore, patients with a high CID tended to have worse DFS in the PN versus RN group (p = 0.044). Multivariable Cox regression showed that PN (HR, 2.049; 95 % CI, 1.065-3.942; p = 0.032) and WHO/ISUP grade III-IV (HR, 2.148; 95 % CI, 1.189-3.881; p = 0.011) were independent prognostic factors of DFS in the high CID group.
CONCLUSIONS
CID is a reliable preoperative parameter which is positively correlated with WHO/ISUP grade and can help with surgical decision-making in patients with T1bN0M0 RCC.
目的
确定肿瘤轮廓不规则程度（CID）在 T1bN0M0 肾细胞癌（RCC）手术策略选择中的预后价值。
材料与方法
我们对 2009 年 1 月至 2019 年 6 月期间接受治疗的 489 例 T1bN0M0 RCC 患者进行了回顾性多机构研究。采用 Cox 回归和 Kaplan-Meier 分析来分析 CID 对无病生存（DFS）的影响。
结果
55 例（11.2%）患者出现转移或复发，中位随访时间为 55 个月（四分位距，40-81 个月）。逻辑分析表明 CID 与世界卫生组织/国际泌尿病理学会（WHO/ISUP）分级 III-IV 相关（优势比，1.015；95%置信区间 [CI]，1.008-1.023；p<0.001）。将 CID 分为高 CID（≥50%）和低 CID（<50%）两组后，高 CID 组的 WHO/IUSP 分级 III-IV 比例明显更高（74/277 [26.7%] vs 25/212 [11.8%]），DFS 更短（p<0.001）。多变量 Cox 回归显示，部分肾切除术（PN；风险比 [HR]，1.889；95%CI，1.020-3.499；p=0.043）、高 CID（HR，6.685；95%CI，2.776-16.100；p<0.001）和 WHO/ISUP 分级 III-IV（HR，1.950；95%CI，1.100-3.458；p=0.022）是 DFS 的独立预后因素。Kaplan-Meier 图显示 PN 的 DFS 率与根治性肾切除术（RN；p=0.994）相当。在低 CID 组中，行 PN 的患者与行 RN 的患者的 DFS 相当（p=0.903）。此外，高 CID 患者在 PN 与 RN 组中的 DFS 更差（p=0.044）。多变量 Cox 回归显示，PN（HR，2.049；95%CI，1.065-3.942；p=0.032）和 WHO/ISUP 分级 III-IV（HR，2.148；95%CI，1.189-3.881；p=0.011）是高 CID 组 DFS 的独立预后因素。
结论
CID 是一种可靠的术前参数，与 WHO/ISUP 分级呈正相关，可帮助 T1bN0M0 RCC 患者做出手术决策。
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