Prognostic Factors and Survival of Renal Clear Cell Carcinoma Patients with Bone Metastases
Prognostic Factors and Survival of Renal Clear Cell Carcinoma Patients with Bone Metastases
复制标题
DOI：
10.1007/s12253-009-9184-7
复制
发表时间：
2010-03-01
影响因子：
2.8
通讯作者：
Szendroi, Miklos
中科院分区：
文献类型：
--
作者：
Szendroi, Attila;Dinya, Elek;Szendroi, Miklos
我们回顾性分析了1990年至2008年间65例肾透明细胞癌骨转移手术患者的病理及临床因素对其生存的影响。根据Kaplan-Meier曲线，年龄、性别、临床症状、病理性骨折、向软组织的进展、转移的位置和大小、多发性转移的发生是多器官还是仅位于骨骼系统以及原发性肾癌的分期和分级对生存没有影响。如果骨转移是孤立的，低Fuhrman分级，晚发，生存率显著提高；并进行了根治性手术。根据Cox回归分析，骨手术后的生存受转移的多样性、转移的程度以及手术的根治性的影响，而肾切除术后的生存受发病时间和转移的程度的显著影响。当单发转移被彻底切除时，75.0%的患者第一年存活，术后第5年存活的比例为35.5%。如果转移灶是多发的或者手术不是根治性的，那么没有患者在第五年存活。这是关于肾细胞癌骨转移的Fuhrman分级预后意义的首次报道。虽然原发肿瘤的Fuhrman分级不影响生存，但转移程度越低，生存时间越长。因此，对于孤立的、可手术的、晚发的转移性肿瘤，建议采用低Fuhrman级根治术，因为35.5%的病例可以预期5年生存率。
In our retrospective study the pathological and clinical factors, influencing the survival of 65 renal clear cell carcinoma patients operated for bone metastasis between 1990 and 2008 were examined. Based on Kaplan-Meier curves age, gender, clinical symptoms, pathological fracture, progression to the soft tissues, localization and size of the metastasis, whether the occurrence of multiplex metastases is multiorganic or only located to the skeletal system and the stage and grade of primary renal cancer did not influence the survival. The survival significantly improved if the bone metastases were solitary, low Fuhrman grade, late onset; and radical surgery was performed. Based on Cox regression analysis, survival after bone surgery was influenced by the multiplicity and grade of metastasis and by the radicality of the surgery, whereas survival after nephrectomy was significantly influenced by onset time and grade of metastasis. When the solitary metastasis was radically removed, 75.0% of the patients survived the first, and 35.5% the fifth postoperative year. If the metastasis was multiple or the surgery was not radical, no patient survived the fifth year. This is the first report on the prognostic significance of the Fuhrman grade of bone metastasis of renal cell cancer. While the Fuhrman grade of the primary tumour did not influence the survival, the lower grade of metastasis was associated with a significant longer survival. Therefore in cases of solitary, operable, late onset metastases with low Fuhrman grade radical removal is recommended, since this way in 35.5% of cases 5 year survival can be expected.