Characteristics of aggressive variants in T1a renal cell carcinoma
Characteristics of aggressive variants in T1a renal cell carcinoma
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DOI：
10.1007/s00432-011-1040-y
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发表时间：
2011-11-01
影响因子：
3.6
通讯作者：
Ozono, Seiichiro
中科院分区：
文献类型：
--
作者：
Takayama, Tatsuya;Sugiyama, Takayuki;Ozono, Seiichiro
探讨T1a型肾细胞癌（RCC）转移及预后的相关因素。我们回顾性分析了1978年至2007年间滨松大学附属医院泌尿外科收治的1060例患者中451例散发性T1aRCC。分析临床病理因素是否有转移和预后风险。我们确定了32例转移性RCC患者，22例为同步转移性RCC， 10例为异时转移性RCC。有转移的患者有症状性癌的发生率明显高于无转移的患者，肿瘤大小、c反应蛋白（CRP）水平、类肉瘤成分比、组织学分级3级及微血管侵犯均明显高于无转移的患者。32例发生转移的患者中，临床病理因素无明显差异。最常见的转移部位是骨。在转移性T1aRCC患者中，诊断为有症状的癌症，CRP水平为0.4 mg/dL或更高，肿瘤大小为3.0 cm或更大，组织学分级为3级，肉瘤样成分和微血管侵犯似乎是重要的独立危险因素。异时性转移性肾细胞癌的重要独立危险因素是有症状的癌症和诊断时的肉瘤样成分。CRP水平为0.4 mg/dL或更高也是总体生存的独立预后因素。诊断为有症状的癌症、肉瘤样成分和CRP水平为0.4 mg/dL或更高的RCC患者需要加强随访。
To explore factors associated with metastasis and prognosis in T1a renal cell carcinoma (RCC).We retrospectively reviewed 451 cases of sporadic T1aRCC among 1,060 patients admitted to the Department of Urology at Hamamatsu University Hospital and affiliated hospitals between 1978 and 2007. Clinicopathological factors were analyzed for metastatic and prognostic risks.We identified 32 RCC patients with metastatic disease, 22 with synchronous and 10 with metachronous metastatic RCC. Patients with metastatic disease had a significantly higher incidence of symptomatic cancer, as well as greater tumor size, C-reactive protein (CRP) level, sarcomatoid component ratio, histological grade 3 and microvascular invasion than those without metastasis. Among the 32 patients with metastasis, there is no significant difference in clinicopathological factors. The most common site of metastasis was bone. Among patients with metastatic T1aRCC, findings at diagnosis of a symptomatic cancer, CRP level of 0.4 mg/dL or more, tumor size of 3.0 cm or greater, histological grade 3, a sarcomatoid component and microvascular invasion appeared to be significant and independent risk factors. Significant independent risk factors with metachronous metastatic RCC were a symptomatic cancer and a sarcomatoid component at diagnosis. A CRP level of 0.4 mg/dL or more was also an independent prognostic factor for overall survival.RCC patients with findings at diagnosis of a symptomatic cancer, a sarcomatoid component and CRP level of 0.4 mg/dL or more require intensive follow-up.