Predictors of postoperative recurrence in patients with non-metastatic pT3a renal cell carcinoma
Predictors of postoperative recurrence in patients with non-metastatic pT3a renal cell carcinoma
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DOI：
10.1111/iju.14648
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发表时间：
2021-08-03
影响因子：
2.6
通讯作者：
Matsuda，Tadashi
中科院分区：
文献类型：
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作者：
Ohsugi，Haruyuki;Ohe，Chisato;Matsuda，Tadashi
目的分析非转移性pT3a肾癌患者肾外肿瘤扩展方式与其他病理因素对术后复发的影响。方法回顾性分析了2006年至2017年在日本大阪平田关西医科大学医院接受根治性手术的587例非转移性肾细胞癌患者。我们提取了114例主要组织学类型的pT3a患者，其中93例为透明细胞肾细胞癌（81.6%），13例为未分类肾细胞癌（11.4%），6例为憎色肾细胞癌（5.3%），2例为乳头状肾细胞癌。主要终点为无复发生存期。采用Kaplan-Meier法和Cox比例风险模型进行统计分析。结果114例pT3a肾细胞癌中，42例（36.8%）复发。多因素分析显示，肾周脂肪侵袭（风险比2.36，P= 0.009）、肉瘤样或横纹肌样成分（风险比2.88，P= 0.022）和坏死（风险比2.34，P= 0.030）是影响无复发生存的独立因素。高危pT3a组有两个以上的独立预测因子，预后较差。高风险pT3a组和pT3b或更高级别组的无复发生存期相似（中位无复发生存期分别为23.0和10.8个月）。结论肾脂肪浸润、肉瘤样或横纹肌样成分和坏死是pT3a显性肾癌患者无复发生存的独立预测因素。具有以上两种预测因子的患者肿瘤预后较差。这些发现将有助于预测复发的风险分层，并为患者咨询提供预后信息。
ObjectiveTo analyze the effect of patterns of extrarenal tumor extension with other pathological factors on postoperative recurrence in patients with non‐metastatic pT3a renal cell carcinoma.MethodsWe retrospectively reviewed 587 non‐metastatic renal cell carcinoma patients who underwent radical surgery between 2006 and 2017 at Kansai Medical University Hospital, Hirakata, Osaka, Japan. We extracted a subset of 114 patients with pT3a of predominant histological types: 93 with clear cell renal cell carcinoma (81.6%), 13 with unclassified renal cell carcinoma (11.4%), six with chromophobe renal cell carcinoma (5.3%) and two with papillary renal cell carcinoma. The primary end‐point was recurrence‐free survival. The Kaplan–Meier method and Cox proportional hazards model were used for statistical analysis.ResultsOf the 114 patients with pT3a renal cell carcinoma, 42 patients (36.8%) experienced recurrence. Multivariate analysis showed that perinephric fat invasion (hazard ratio 2.36,P= 0.009), sarcomatoid or rhabdoid component (hazard ratio 2.88,P= 0.022) and necrosis (hazard ratio 2.34,P= 0.030) were independent factors for recurrence‐free survival. The high‐risk pT3a group, which had more than two independent predictors, had poor prognosis. Recurrence‐free survival of the high‐risk pT3a group and the pT3b or greater group were similar (median recurrence‐free survival 23.0 and 10.8 months, respectively).ConclusionsPerinephric fat invasion, sarcomatoid or rhabdoid component and necrosis are independent predictors of recurrence‐free survival in patients with pT3a‐predominant renal cell carcinoma. Patients with more than two of these predictors have poor oncological outcomes. These findings will aid in risk stratification for predicting recurrence and provide prognostic information for patient counseling.