Van Poppel H, Vandendriessche H, Boel K, Mertens V, Goethuys H, Haustermans K, Van Damme B, Baert L
Department of Urology, University Hospitals, Katholieke Universiteit Leuven, Belgium.
J Urol. 1997 Jul;158(1):45-9. doi: 10.1097/00005392-199707000-00013.
Although many factors have been considered to predict the outcome after radical nephrectomy, renal cell carcinoma continues to behave unpredictably. In a retrospective study the correlation between microvascular tumor invasion and disease-free survival after surgery for renal cell carcinoma was analyzed.
Between 1980 and 1993, 180 patients (mean age 60 years) were followed for a mean of 52 months after radical or partial nephrectomy for clinically localized renal cell carcinoma. The relevance of microscopic vascular invasion was compared to classical tumor staging, grade and tumor diameter.
Microscopic vascular invasion was found in 51 patients (28.3%), including 20 (39.2%) with progression (mean interval to progression 72 months). Of 129 patients with no pathological evidence of microscopic vascular invasion only 8 (6.2%) showed progression at a mean interval of more than 160 months. The difference in disease-free survival as a function of microvascular invasion was statistically highly significant (log rank p < 0.00001) and on multivariate analysis this parameter was by far the most relevant predictor of progression.
In patients who underwent radical nephrectomy for clinically nonmetastatic renal cell carcinoma with microvascular invasion but without lymph node involvement or macroscopic vascular invasion the chance of disease progression is estimated at 45% within 1 year. Microvascular invasion is the single most relevant prognosticator after presumed curative radical nephrectomy for renal cell carcinoma.
尽管已考虑诸多因素来预测根治性肾切除术后的结果，但肾细胞癌的行为仍难以预测。在一项回顾性研究中，分析了肾细胞癌手术切除后微血管肿瘤侵犯与无病生存期之间的相关性。
1980年至1993年间，180例（平均年龄60岁）临床局限性肾细胞癌患者在接受根治性或部分肾切除术后平均随访52个月。将微血管侵犯的相关性与经典的肿瘤分期、分级及肿瘤直径进行比较。
51例（28.3%）患者发现有微血管侵犯，其中20例（39.2%）病情进展（至进展的平均间隔时间为72个月）。129例无微血管侵犯病理证据的患者中，仅8例（6.2%）出现病情进展，平均间隔时间超过160个月。无病生存期因微血管侵犯而产生的差异在统计学上具有高度显著性（对数秩检验p<0.00001），多因素分析显示该参数是病情进展最相关的预测指标。
对于临床无转移的肾细胞癌患者，若存在微血管侵犯但无淋巴结受累或肉眼可见的血管侵犯，行根治性肾切除术后1年内疾病进展的几率估计为45%。微血管侵犯是肾细胞癌根治性肾切除术后最相关的单一预后指标。
