Metastatic renal cell carcinoma risk according to tumor size.
Metastatic renal cell carcinoma risk according to tumor size.
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根据肿瘤大小，转移性肾细胞癌风险。
DOI：
10.1016/j.juro.2009.02.128
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发表时间：
2009-07
期刊：
影响因子：
--
通讯作者：
Russo P
中科院分区：
文献类型：
--
作者：
Thompson RH;Hill JR;Babayev Y;Cronin A;Kaag M;Kundu S;Bernstein M;Coleman J;Dalbagni G;Touijer K;Russo P
最近的证据表明，肾细胞癌（RCC）的肿瘤大小和转移的风险显着不一致的结果。在此，我们介绍我们的经验与肾细胞癌和评估之间的关联肿瘤大小和转移的风险，在一个大型队列的患者。利用我们前瞻性维护的肾切除术数据库，我们确定了1989年至2008年间2,691例因散发性肾皮质肿瘤接受手术治疗的患者。采用逻辑回归模型评估肿瘤大小与出现同步转移（M1 RCC）之间的关系，同时采用Kaplan-Meier方法估计2，367例未出现M1 RCC并接受术后随访的患者术后无瘤生存率。在2，691名患者中，162名患有转移性RCC。781例肿瘤<3cm的患者中只有1例在就诊时患有M1 RCC，肿瘤大小与就诊时的转移显著相关（每增加1cm，比值比为1.25，p<0.001）。在2，367例未出现转移的患者中，171例在中位随访2.8年期间发生转移性疾病。在该组中，720例RCC <3cm的患者中只有1例在随访期间发生了原发转移。无转移生存率与肿瘤大小显著相关（每增加1 cm，风险比为1.24，p<0.001）。在我们的经验中，肿瘤大小与肾切除术后的同步转移和异步转移显著相关。我们的研究结果表明，肿瘤<3cm的患者发生转移性疾病的风险可以忽略不计。
Recent evidence suggests significantly discordant findings regarding tumor size and the risk of metastases in renal cell carcinoma (RCC). Herein, we present our experience with RCC and evaluate the association between tumor size and risk of metastases in a large cohort of patients. Using our prospectively maintained nephrectomy database, we identified 2,691 patients treated surgically for a sporadic renal cortical tumor between 1989 and 2008. Associations between tumor size and synchronous metastases at presentation (M1 RCC) were evaluated with logistic regression models while metastases-free survival following surgery was estimated using the Kaplan-Meier method for 2,367 patients who did not present with M1 RCC and who were followed postoperatively. Among the 2,691 patients, 162 presented with metastatic RCC. Only 1 of 781 patients with a tumor <3cm had M1 RCC at presentation and tumor size was significantly associated with metastases at presentation (odds ratio 1.25 for each 1cm increase, p<0.001). Among the 2,367 patients who did not present with metastases, 171 developed metastatic disease during a median follow-up of 2.8 years. In this group, only 1 of the 720 patients with RCC <3cm developed a de novo metastases during follow-up. Metastases-free survival was significantly associated with tumor size (hazard ratio 1.24 for each 1cm increase, p<0.001). In our experience, tumor size is significantly associated with synchronous metastases and asynchronous metastases following nephrectomy. Our results suggest that risk of metastatic disease for patients with tumors <3cm is negligible.
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