The Prognostic Impact of a Positive Vascular Margin on pT3 Clear Cell Renal Cell Carcinoma.
The Prognostic Impact of a Positive Vascular Margin on pT3 Clear Cell Renal Cell Carcinoma.
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DOI：
10.1016/j.juro.2015.08.099
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发表时间：
2016-02
期刊：
影响因子：
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通讯作者：
Coleman JA
中科院分区：
文献类型：
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作者：
Liu NW;Wren JD;Vertosick E;Lee JK;Power NE;Benfante NE;Kimm SY;Bains MS;Sjoberg DD;Russo P;Coleman JA
我们研究了 pT3 透明细胞肾细胞癌患者血管切缘阳性的影响。在排除非血管切缘阳性、转移、淋巴结受累、新辅助治疗或非透明细胞组织学的患者后，我们通过我们的机构数据库从 1999 年至 2013 年确定了 224 名静脉肿瘤侵犯的患者。 Kaplan-Meier 分析和对数秩检验用于评估阳性血管边缘是否与无进展生存或癌症特异性生存相关。四十一名患者 (18%) 的血管切缘呈阳性。边缘状态与浸润程度直接相关（p <0.0001）。与血管边缘阴性组相比，阳性组的无进展生存期显着较差（p=0.01），但癌症特异性生存期则较差（p=0.3）。同样，血管血栓侵袭水平与较差的无进展生存期显着相关（p=0.02），但与癌症特异性生存期无关（p=0.4）。下腔静脉侵犯的三年无进展生存期最差，节段性/肌性静脉分支侵犯的三年无进展生存期最好（54% [95% CI 34–70] vs. 76% [95% CI 64–85]）。在仅有主肾静脉血栓的患者中，血管边缘状态与无进展生存期 (p=0.5) 或癌症特异性生存期 (p=0.2) 无关。在 pT3N0/XM0 透明细胞肾细胞癌患者中，血管切缘阳性与疾病进展风险相关。然而，与血管切缘阳性相关的复发风险是由血管血栓侵入的程度决定的。这些发现表明，目前在 pT3 透明细胞肾细胞癌中定义的血管边缘状态的临床意义很小。
We examined the impact of positive vascular margins in patients with pT3 clear cell renal cell carcinoma. After excluding patients with non-vascular positive margins, metastasis, lymph node involvement, neoadjuvant therapy, or non–clear cell histology, we identified 224 patients with venous tumor invasion through our institutional database from 1999-2013. Kaplan-Meier analysis and log rank tests were used to evaluate whether positive vascular margins were associated with progression-free survival or cancer-specific survival. Forty-one patients (18%) had a positive vascular margin. Margin status was directly related to the level of invasion (p <0.0001). Compared to the negative vascular margin group, the positive group had significantly worse progression-free survival (p=0.01), but not cancer-specific survival (p=0.3). Similarly, level of vascular thrombus invasion was significantly associated with worse progression-free survival (p=0.02), but not cancer-specific survival (p=0.4). Three-year progression-free survival was worst with inferior vena cava invasion and best with segmental/muscular venous branch invasion (54% [95% CI 34–70] vs. 76% [95% CI 64–85]). Among patients with only main renal vein thrombus, vascular margin status was not associated with progression-free survival (p=0.5) or cancer-specific survival (p=0.2). In patients with pT3N0/XM0 clear cell renal cell carcinoma, positive vascular margins are associated with risk for disease progression. However, the risk of relapse associated with positive vascular margin is driven by extent of vascular thrombus invasion. These findings suggest that the clinical significance of vascular margin status as currently defined in pT3 clear cell renal cell carcinoma is minimal.