Microscopic vascular invasion is the most relevant prognosticator after radical nephrectomy for clinically nonmetastatic renal cell carcinoma
Microscopic vascular invasion is the most relevant prognosticator after radical nephrectomy for clinically nonmetastatic renal cell carcinoma
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DOI：
10.1097/00005392-199707000-00013
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发表时间：
1997-07-01
影响因子：
6.6
通讯作者：
Baert, L
中科院分区：
文献类型：
--
作者：
VanPoppel, H;Vandendriessche, H;Baert, L
目的：尽管许多因素被认为可以预测根治性肾切除术后的结果，但肾癌的表现仍然不可预测。在一项回顾性研究中，肾细胞癌手术后微血管肿瘤浸润和无病生存之间的相关性进行了analysed.Materials和方法：1980年和1993年之间，180例（平均年龄60岁）进行了随访，平均52个月后，根治性或部分肾切除术的临床局限性肾细胞癌。结果：51例（28.3%）患者出现显微镜下血管浸润，其中20例（39.2%）进展（平均进展时间72个月）。在129例无显微镜下血管浸润病理学证据的患者中，仅8例（6.2%）显示进展，平均间隔超过160个月。无病生存率作为微血管侵犯的函数的差异具有高度统计学意义（log rank p < 0.00001），并且在多变量分析中，该参数是迄今为止最相关的进展预测因子。在因临床非转移性肾细胞癌伴微血管浸润而接受根治性肾切除术但无淋巴结受累或肉眼血管浸润的患者中，疾病进展估计在1年内为45%。微血管浸润是肾癌根治性切除术后最重要的决定因素。
Purpose: Although many factors have been considered to predict the outcome after radical nephrectomy, renal cell carcinoma continues to behave unpredictably. In a retrospective study the correlation between microvascular tumor invasion and disease-free survival after surgery for renal cell carcinoma was analyzed.Materials and Methods: Between 1980 and 1993, 180 patients (mean age 60 years) were followed for a mean of 52 months after radical or partial nephrectomy for clinically localized renal cell carcinoma. The relevance of microscopic vascular invasion was compared to classical tumor staging, grade and tumor diameter.Results: Microscopic vascular invasion was found in 51 patients (28.3%), including 20 (39.2%) with progression (mean interval to progression 72 months). Of 129 patients with no pathological evidence of microscopic vascular invasion only 8 (6.2%) showed progression at a mean interval of more than 160 months. The difference in disease-free survival as a function of microvascular invasion was statistically highly significant (log rank p < 0.00001) and on multivariate analysis this parameter was by far the most relevant predictor of progression.Conclusions: In patients who underwent radical nephrectomy for clinically nonmetastatic renal cell carcinoma with microvascular invasion but without lymph node involvement or macroscopic vascular invasion the chance of disease progression is estimated at 45% within 1 year. Microvascular invasion is the single most relevant prognosticator after presumed curative radical nephrectomy for renal cell carcinoma.