The follow-up management of non-metastatic renal cell carcinoma: definition of a surveillance protocol
The follow-up management of non-metastatic renal cell carcinoma: definition of a surveillance protocol
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DOI：
10.1111/j.1464-410x.2006.06616.x
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发表时间：
2007-02-01
影响因子：
4.5
通讯作者：
Simeone, Claudio
中科院分区：
文献类型：
--
作者：
Antonelli, Alessandro;Cozzoli, Alberto;Simeone, Claudio
目的探讨加州大学洛杉矶综合分期系统（UISS）对N 0/NXM 0肾癌（RCC）根治术后的随访方案。回顾性分析了1983年至2005年期间1399例手术治疗的肾肿瘤患者的随访时间（无病患者>= 24个月）。每个病例被分配一个UISS风险类别;记录复发特征、时间和部位。特别是，复发部位分为本地，肾（同侧或对侧）和远程（单网站或散布）。结果的记录进行了审查的814例患者的平均随访75.6个月。UISS风险类别分布如下：高风险（HR）17.2%，中风险（IR）51.6%，低风险（LR）31.2%。5年无病生存率分别为63.9%、88.3%和96.5%（log-rank检验P < 0.001）。193例患者（23.7%）复发，其中远端复发（73.0%），局部复发（11.9%），对侧肾复发（10.9%），同侧肾复发（4.1%）。UISS分级与远处或局部复发（均P < 0.001）的风险显著相关，而与手术肾（P = 0.372）或对侧肾（P = 0.898）的复发无相关性。结论UISS分级对远处和局部复发的预测准确性和适用性得到证实，而肾复发具有独立的病程。建议根据每个UISS风险组中观察到的复发模式制定随访计划。
OBJECTIVE To define a follow-up protocol based on the University of California Los Angeles Integrated Staging System (UISS) for patients undergoing surgery for N0M0 renal cell carcinoma (RCC).PATIENTS AND METHODS The clinical records of patients treated with radical surgery for N0/NXM0 RCC and monitored through periodic follow-up studies (>= 24 months in disease-free patients) were reviewed retrospectively from 1399 patients surgically treated for renal neoplasms between 1983 and 2005. Each case was assigned a UISS risk category; recurrence features, time and site were recorded. In particular, recurrence sites were categorized into local, renal (ipsilateral or contralateral) and distant (single-site or disseminated).RESULTS The records were reviewed of 814 patients with a mean follow-up of 75.6 months. UISS risk categories were distributed as follows: high-risk (HR) 17.2%, intermediate-risk (IR) 51.6% and low-risk (LR) 31.2%. Disease-free survival rates at 5 years were 63.9%, 88.3% and 96.5% (log-rank test P < 0.001), respectively. The disease recurred in 193 patients (23.7%), at distant sites (73.0% of recurrences), locally (11.9%), in the contralateral kidney (10.9%) and in the ipsilateral kidney (4.1%). There was a significant correlation between UISS category and risk of distant or local (both P < 0.001) recurrences, whereas there was no correlation of recurrences in the operated kidney (P = 0.372) or contralateral kidney (P = 0.898).CONCLUSIONS The prognostic accuracy and applicability of the UISS for distant and local recurrences is confirmed, whereas renal relapses have an independent course. A follow-up scheme tailored to the recurrence patterns observed in each UISS risk group is recommended.