Prognostic Impact of the 2009 UICC/AJCC TNM Staging System for Renal Cell Carcinoma with Venous Extension
Prognostic Impact of the 2009 UICC/AJCC TNM Staging System for Renal Cell Carcinoma with Venous Extension
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DOI：
10.1016/j.eururo.2010.10.001
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发表时间：
2011-01-01
期刊：
影响因子：
23.4
通讯作者：
Libertino, John A.
中科院分区：
文献类型：
--
作者：
Martinez-Salamanca, Juan I.;Huang, William C.;Libertino, John A.
背景：肾细胞癌（RCC）静脉受累和癌栓水平的预后意义仍存在很大争议。2010年，美国癌症联合委员会（AJCC）和联合国际癌症中心（UICC）修订了RCC分期系统（第7版）基于肿瘤血栓水平，区分仅累及肾静脉的肿瘤的T分期。目的：我们旨在评估肿瘤血栓扩展对多机构患者队列的影响。设计、设置和参与者：成立了一个由11家机构组成的国际联盟，回顾性审查了1215名接受根治性肾切除术和肿瘤血栓切除术治疗RCC的患者的联合队列，其中包括585名累及下腔静脉（IVC）或以上的患者。测量：生存的预测因素，包括组织学，肿瘤血栓水平，淋巴结状态，Fuhrman分级和肿瘤大小，进行了分析。共审查了1122例数据完整的患者。所有患者的中位随访时间为24.7个月，中位生存期为33.8个月。5年生存率分别为43.2%（肾静脉受累）、37%（膈下下腔静脉受累）和22%（膈上腔静脉受累）。在多变量分析中，肿瘤大小（风险比[HR]：1.64 [范围：1.03-2.59]; p = 0.036），Fuhrman分级（HR：2.26 [范围：1.65-3.1]; p = 0.000），淋巴结转移（HR：1.32 [范围：1.09-1.67]; p = 0.005）和肿瘤血栓水平（HR：2.10 [范围：1.53-3.0]; p = 0.00）与生存独立相关。基于对已知最大的RCC患者队列（沿着IVC和心房血栓受累）的分析，肿瘤血栓水平是生存率的独立预测因子。我们的研究结果支持最新AJCC/UICC分期系统的变化。(C)2010年欧洲泌尿外科协会。Elsevier B. V.出版，保留所有权利。
Background: The prognostic significance of venous involvement and tumour thrombus level in renal cell carcinoma (RCC) remains highly controversial. In 2010, the American Joint Committee on Cancer (AJCC) and the Union International Centre le Cancer (UICC) revised the RCC staging system (7th edition) based on tumour thrombus level, differentiating the T stage of tumours limited to renal-vein-only involvement.Objective: We aimed to evaluate the impact of tumour thrombus extension in a multi-institutional cohort of patients.Design, setting, and participants: An international consortium of 11 institutions was established to retrospectively review a combined cohort of 1215 patients undergoing radical nephrectomy and tumour thrombectomy for RCC, including 585 patients with inferior vena cava (IVC) involvement or higher.Measurements: Predictive factors of survival, including histology, tumour thrombus level, nodal status, Fuhrman grade, and tumour size, were analysed.Results and limitations: A total of 1122 patients with complete data were reviewed. The median follow-up for all patients was 24.7 mo, with a median survival of 33.8 mo. The 5-yr survival was 43.2% (renal vein involvement), 37% (IVC below the diaphragm), and 22% with caval involvement above the diaphragm. On multivariate analysis, tumour size (hazard ratio [HR]: 1.64 [range: 1.03-2.59]; p = 0.036), Fuhrman grade (HR: 2.26 [range: 1.65-3.1]; p = 0.000), nodal metastasis (HR: 1.32 [range: 1.09-1.67]; p = 0.005), and tumour thrombus level (HR: 2.10 [range: 1.53-3.0]; p = 0.00) correlated independently with survival.Conclusions: Based on analysis of the largest known cohort of patients with RCC along with IVC and atrial thrombus involvement, tumour thrombus level is an independent predictor of survival. Our findings support the changes to the latest AJCC/UICC staging system. (C) 2010 European Association of Urology. Published by Elsevier B.V. All rights reserved.