Positive vascular wall margins have minimal impact on cancer outcomes in patients with non-metastatic renal cell carcinoma (RCC) with tumour thrombus
Positive vascular wall margins have minimal impact on cancer outcomes in patients with non-metastatic renal cell carcinoma (RCC) with tumour thrombus
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DOI：
10.1111/bju.12515
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发表时间：
2014-11-01
影响因子：
4.5
通讯作者：
Wood, Christopher G.
中科院分区：
文献类型：
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作者：
Abel, E. Jason;Carrasco, Alonso;Wood, Christopher G.
目的探讨血管边缘镜下阳性对肾细胞癌（RCC）伴静脉血栓患者复发及肿瘤特异性生存（CSS）的影响。患者与方法我们回顾了1993年至2009年在德克萨斯大学MD安德森癌症中心连续接受肾细胞癌伴静脉肿瘤血栓手术治疗的患者的记录。排除在取栓时有转移性疾病、软组织边缘阳性或大体残留疾病的患者。主要结局指标为局部或全身性疾病复发和CSS。采用单因素和多因素分析来评估镜下血管边缘阳性是否与肾切除术合并血栓切除术后的RCC复发或CSS相关。结果共发现256例RCC患者，中位（四分位间距）随访36.7（18.4-63.5）个月。47例（18.4%）患者在切除边缘可见显微肿瘤。血管边缘阳性患者的中位无复发间隔明显缩短：22.1个月vs 70.2个月（P = 0.009）。静脉边缘阳性患者的局部复发率为12.8%比4.3% （P < 0.01）。256例患者中只有2例（0.8%）发现局部复发而无全身复发。血管边缘阳性患者的CSS时间明显差于血管边缘阴性患者：37.7个月vs 93.0个月（P = 0.004）。在多变量分析中，血管边缘阳性可独立预测局部复发，但不能预测全身复发或CSS。结论血管壁边缘阳性会增加局部复发率，应尝试完全手术切除。RCC在切除边缘侵入静脉壁与肿瘤生物学的侵袭性有关，大多数血管壁边缘呈阳性的患者会出现全身复发。
Objective To evaluate the impact of microscopically positive vascular margins on recurrence and cancer-specific survival (CSS) in patients with renal cell carcinoma (RCC) with venous thrombusPatients and Methods We reviewed the records from the period 1993 to 2009 of consecutive patients treated surgically for RCC with venous tumour thrombus at the University of Texas MD Anderson Cancer Center. Patients with metastatic disease, positive soft tissue margins or gross residual disease at time of thrombectomy were excluded. The primary outcome measures were local or systemic disease recurrence, and CSS. Univariate and multivariate analysis were used to evaluate whether microscopically positive vascular margins were associated with RCC recurrence or CSS after nephrectomy with thrombectomy.Results A total of 256 patients with RCC were identified with a median (interquartile range) follow-up of 36.7 (18.4-63.5) months. Microscopic tumour was present at the margin of resection in 47 patients (18.4%). The median recurrence-free interval was significantly shorter in patients with positive vascular margins: 22.1 vs 70.2 months (P = 0.009). The rate of local recurrence was higher in patients with positive vein margins: 12.8 vs 4.3% (P < 0.01). Local recurrence without concomitant systemic recurrence was identified in only two of 256 (0.8%) patients. Patients with positive vascular margins had significantly worse CSS times compared with patients with negative vascular margins: 37.7 vs 93.0 months (P = 0.004). In multivariable analysis, positive vascular margins were found to be independently predictive of local recurrence but not of systemic recurrence or CSS.Conclusions Complete surgical excision should always be attempted because positive vascular wall margins increase local recurrence rates. Invasion of RCC into the vein wall at the resection margin is associated with aggressive tumour biology, and the majority of patients with positive vascular wall margins experience systemic recurrence.