Tobe Taisuke, Teishima Jun, Ueki Hideto, Shiraishi Yusuke, Wakita Naoto, Okamura Yasuyoshi, Suzuki Kotaro, Bando Yukari, Hara Takuto, Terakawa Tomoaki, Chiba Koji, Yao Akihisa, Miyake Hideaki
Division of Urology, Department of Surgery Related, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki, Chuo-Ku, Kobe, Hyogo, 650-0017, Japan.
Int J Clin Oncol. 2025 Jul 14. doi: 10.1007/s10147-025-02825-y.
To identify prognostic factors that guide adjuvant therapy decisions, we investigated factors predicting recurrence in patients with high-risk clear cell renal cell carcinoma (RCC) after nephrectomy.
We retrospectively reviewed patients with non-metastatic, high-risk clear cell RCC who underwent radical or partial nephrectomy at our institution and affiliated centers between January 2016 and March 2024. Multivariate analysis using the Cox proportional hazards model was performed to identify clinicopathological factors associated with recurrence. On the basis of these factors, we developed a risk stratification model.
A total of 338 patients were included. The 5-year recurrence-free survival (RFS) rate was 54.3%. Multivariate analysis identified a body mass index of ≤ 22 kg/m (Hazard Ratio [HR]: 2.61), rhabdoid differentiation (HR: 5.14), anemia (HR: 1.97), hypercalcemia (HR: 2.67), and C-reactive protein ≥ 0.5 mg/dL (HR: 1.72) as independent predictors of recurrence. RFS was significantly different between patients with varying numbers of risk factors: 3-year RFS rates were 22.6% for those with 3-4 factors, 47.9% for those with two, 75.5% for those with one, and 83.6% for those with none.
We identified independent predictors of recurrence in patients with nephrectomy-treated clear cell RCC. Patients stratified according to a risk score based on these factors had different recurrence rates, suggesting that this score could assist in guiding adjuvant therapy decisions.
为了确定指导辅助治疗决策的预后因素，我们研究了高危透明细胞肾细胞癌（RCC）患者肾切除术后复发的预测因素。
我们回顾性分析了2016年1月至2024年3月期间在我们机构及附属中心接受根治性或部分肾切除术的非转移性高危透明细胞RCC患者。采用Cox比例风险模型进行多因素分析，以确定与复发相关的临床病理因素。基于这些因素，我们建立了一个风险分层模型。
共纳入338例患者。5年无复发生存率（RFS）为54.3%。多因素分析确定体重指数≤22kg/m（风险比[HR]：2.61）、横纹肌样分化（HR：5.14）、贫血（HR：1.97）、高钙血症（HR：2.67）和C反应蛋白≥0.5mg/dL（HR：1.72）为复发的独立预测因素。不同风险因素数量的患者RFS有显著差异：有3 - 4个因素的患者3年RFS率为22.6%，有2个因素的患者为47.9%，有1个因素的患者为75.5%，无风险因素的患者为83.6%。
我们确定了肾切除术后透明细胞RCC患者复发的独立预测因素。根据基于这些因素的风险评分进行分层的患者复发率不同，表明该评分有助于指导辅助治疗决策。
