Hirata Hiroshi, Fujii Nakanori, Oka Shintaro, Nakamura Kimihiko, Shimizu Kosuke, Kobayashi Keita, Hiroyoshi Toshiya, Isoyama Naohito, Shiraishi Koji
Department of Urology, Graduate School of Medicine, Yamaguchi University, Yamaguchi, Japan.
Cancer Diagn Progn. 2024 Nov 3;4(6):748-753. doi: 10.21873/cdp.10391. eCollection 2024 Nov-Dec.
BACKGROUND/AIM: Some patients with renal cell carcinoma (RCC) develop early or late recurrence after surgery. However, there is no clear consensus on which patients with postoperative RCC should be treated. This study aimed to establish a biomarker for selecting patients who are at a higher risk of relapse following renal cancer surgery.
A total of 378 patients who underwent nephrectomy or partial nephrectomy for a diagnosis of RCC at our hospital were included, with a focus on pT3 cases at high risk of recurrence. Factors associated with postoperative progression, including pathological and hematological parameters, were examined.
Sarcomatoid features, Fuhrman grade 4, and C-reactive protein-albumin-lymphocyte (CALLY) index were statistically significant predictive factors for progression-free survival after surgery (p<0.0011, p=0.0047, and p<0.0001, respectively). In the multivariate Cox proportional regression analysis, the CALLY index was the most statistically significant predictor of the risk of postoperative recurrence (p=0.0002).
In addition to the existing risk factors for RCC recurrence, such as sarcomatoid features and Fuhrman grade, we propose that the CALLY index is a predictor of postoperative recurrence and that patients with a low CALLY index are good candidates for postoperative treatment. Our study may help select patients with pT3 disease with a high risk of recurrence who require postoperative treatment.
背景/目的：一些肾细胞癌（RCC）患者在手术后会出现早期或晚期复发。然而，对于哪些术后RCC患者应接受治疗，目前尚无明确共识。本研究旨在建立一种生物标志物，用于筛选肾癌手术后复发风险较高的患者。
纳入我院378例因诊断为RCC而接受肾切除术或部分肾切除术的患者，重点关注复发风险较高的pT3病例。研究了与术后进展相关的因素，包括病理和血液学参数。
肉瘤样特征、Fuhrman 4级以及C反应蛋白-白蛋白-淋巴细胞（CALLY）指数是术后无进展生存期的统计学显著预测因素（分别为p<0.0011、p=0.0047和p<0.0001）。在多变量Cox比例回归分析中，CALLY指数是术后复发风险最具统计学意义的预测因素（p=0.0002）。
除了RCC复发的现有风险因素，如肉瘤样特征和Fuhrman分级外，我们提出CALLY指数是术后复发的预测指标，CALLY指数低的患者是术后治疗的良好候选者。我们的研究可能有助于筛选出复发风险高且需要术后治疗的pT3疾病患者。
