Reclassification of the current tumor, node, metastasis staging in pT3 renal cell carcinoma
Reclassification of the current tumor, node, metastasis staging in pT3 renal cell carcinoma
复制标题
DOI：
10.1111/j.1442-2042.2008.02062.x
复制
发表时间：
2008-07-01
影响因子：
2.6
通讯作者：
Baba, Shiro
中科院分区：
文献类型：
--
作者：
Fujita, Tetsuo;Iwamura, Masatsugu;Baba, Shiro
目的：尽管肾细胞癌（RCC）的肿瘤、淋巴结、转移（TNM）分期分类最后一次修改是在2002年，但pT 3分期仍有争议。有人建议，直接肾上腺受累和pT 3b与pT 3a应重新分类。本研究相应地探讨了目前的2002年TNM分期在pT 3 RCCs.Methods的重新分类：共111例pT 3 RCC谁接受了根治性肾切除术在我们的机构1972年3月至2006年2月参加了这项研究。由一名病理学家审查组织学样本。根据pT 3a仅累及肾周脂肪（pT 3a-fat）、pT 3a累及肾上腺（pT 3a-ad）、pT 3b无pT 3a因子（pT 3b-only）、pT 3b伴pT 3a因子（pT 3b伴pT 3a）或pT 3c的重新分类比较疾病特异性生存率。pT 3a-脂肪组和pT 3b-单独组的平均疾病特异性生存时间显著更长：分别为124.1 ± 13.2（SE）个月和70.9 ± 9.1（SE）个月，而pT 3a-ad为24.7 ± 6.7（SE）个月（分别为P = 0.0004和0.0010），pT 3b和pT 3a组为25.0 +/- 4.4（SE）个月（分别为P = 0.0009和0.0032）。在多因素分析中，直接同侧肾上腺受累被认为是预后不良的预测因子（P = 0.0331）。结论：pT 3a患者的直接同侧肾上腺受累和pT 3b患者的肾周脂肪或肾上腺受累应重新分类为接近pT 4。
Objectives: Although the tumor, node, metastasis (TNM) staging classification of renal cell carcinoma (RCC) was last modified in 2002, pT3 staging has continued to be debated. It has been suggested that direct adrenal gland involvement and pT3b with pT3a should be reclassified. This study accordingly explores reclassification of the current 2002 TNM staging in pT3 RCCs.Methods: A total of 111 patients with pT3 RCC who underwent radical nephrectomy at our institution between March 1972 and February 2006 were enrolled in this study. Histological samples were reviewed by a single pathologist. Disease-specific survival was compared according to reclassification as pT3a with perirenal fat involvement only (pT3a-fat), pT3a with adrenal gland involvement (pT3a-ad), pT3b without pT3a factors (pT3b-only), pT3b with pT3a factors (pT3b with pT3a), or pT3c.Results: Seven patients were identified as having pT3a-ad and 20 patients as having pT3b with pT3a. The mean disease-specific survival times in pT3a-fat and pT3b-only were significantly longer: 124.1 +/- 13.2 (SE) months and 70.9 +/- 9.1 (SE) months, respectively, compared with 24.7 +/- 6.7 (SE) months in pT3a-ad (P = 0.0004 and 0.0010, respectively), and 25.0 +/- 4.4 (SE) months in pT3b with pT3a (P = 0.0009 and 0.0032, respectively). On multivariate analysis, the presence of direct ipsilateral adrenal gland involvement was recognized as a predictor of poor prognosis (P = 0.0331).Conclusions: Direct ipsilateral adrenal gland involvement for patients with pT3a, and perirenal fat or adrenal gland involvement for patients with pT3b should be reclassified nearly to pT4.