Renal cell carcinoma: Evaluation of the 1997 TNM system and recommendations for follow-up after surgery
Renal cell carcinoma: Evaluation of the 1997 TNM system and recommendations for follow-up after surgery
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DOI：
10.1159/000052525
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发表时间：
2001-06-01
期刊：
影响因子：
23.4
通讯作者：
Pode, D
中科院分区：
文献类型：
--
作者：
Gofrit, ON;Shapiro, A;Pode, D
目的：探讨局限性肾癌根治术或保留肾单位手术后肿瘤复发的规律。方法：回顾分析1982年1月至1997年12月手术治疗的200例局限性肾细胞癌(RCC)患者的预后。根治性肾切除术155例(77.5%)，保留肾单位手术45例(22.5%)。结果：病理T1期124例(62%)，T2期26例(13%)，T3期50例(25%)，其中T3a期41例，T3b期8例，T3c期1例。平均随访47个月(6~169个月)。4例T1期患者(3.2%)、6例T2期患者(23%)和13例T3期患者(26%)复发。肿瘤直径小于4 cm的TI期患者无一例复发。保留肾单位手术后无复发，而根治性肾切除术后复发23例(14.8%)(p=0.01)。常规胸部CT发现直径小于2.5 cm的无症状转移灶，行肺叶切除术者仅1例获得长期生存。结论：直径小于4 cm的肾癌根治性切除术后患者预后良好，无需放射学随访。T1肿瘤较大、直径4~7 cm或分期较高的患者，应每隔6个月行一次胸部和腹部CT扫描，连续5年，然后每年进行一次。小肾肿瘤部分切除后，应定期行肾脏超声检查，以排除手术肾局部复发。版权所有(C)2001 S.Karger AG，巴塞尔。
Objective: We evaluated the tumor recurrence pattern after radical or nephron-sparing surgery for localized renal cell carcinoma. Based on this pattern, we suggest a surveillance protocol after surgery.Methods: The outcome of 200 consecutive patients with localized renal cell carcinoma (RCC) that were operated on between January 1982 and December 1997 was evaluated retrospectively. Radical nephrectomy was performed in 155 patients (77.5%), and nephron-sparing surgery in 45 patients (22.5%). The timing and site of disease recurrence were correlated with parameters of the primary tumor.Results: One hundred and twenty-four patients (62%) had pathological stage T1, 26 (13%) had stage T2, and 50 (25%) had stage T3 (41 stage T3a, 8 stage T3b, and 1 stage T3c). The mean follow-up was 47 months (range 6-169 months). Four patients (3.2%) with stage T1, 6 patients (23%) with T2, and 13 patients (26%) with T3 developed recurrent disease. None of the patients with a stage TI tumor, smaller than 4 cm, had tumor recurrence. There were no recurrences after nephron-sparing surgery compared to 23 recurrences (14.8%) among patients after radical nephrectomy (p = 0.01). Only 1 patient who underwent pulmonary lobectomy for asymptomatic metastases smaller than 2.5 cm, found by routine chest CT, attained long-term survival.Conclusions: The prognosis of patients after radical nephrectomy for renal cell carcinoma, smaller than 4 cm, is excellent and they do not need radiological follow-up. Patients with larger T1 tumors, 4-7 cm in diameter, or a higher stage should be followed with CT of the chest and abdomen done every 6 months for 5 years and then annually. Following partial nephrectomy of small renal tumors periodic renal ultrasonography should be done to rule out local recurrence in the operated kidney. Copyright (C) 2001 S. Karger AG, Basel.