Prognostic significance of microvascular invasion in localized renal cell carcinoma
Prognostic significance of microvascular invasion in localized renal cell carcinoma
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DOI：
10.1159/000020370
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发表时间：
2000-12-01
期刊：
影响因子：
23.4
通讯作者：
Sade, M
中科院分区：
文献类型：
--
作者：
Sevinc, M;Kirkali, Z;Sade, M
目的：肾癌的根治性切除是治疗局限性甚至晚期肾癌的主要手段。然而，这些患者中有30%在根治性肾切除术后进展。在接受根治性肾切除术的患者中，需要预后因素来确定病程。为探讨微血管浸润（MVI）对肾癌患者预后的影响，对1989年6月至1999年2月间41例无转移、无淋巴结转移、无静脉侵犯的肾癌患者行根治性肾切除术后的病理切片进行MVI检测。MVI与肿瘤分级和肿瘤大小有关（p = 0.032，p = 0.017）。在肉瘤样型RCC中，MVI比其他组织学类型更常见（p = 0.003）。中位随访48个月后，MVI患者的进展率为29%，无MVI患者为17%（p = 0.001）。MVI患者的中位进展时间为3个月，无MVI患者为41个月（p = 0.01）。在中位随访48个月期间，MVI患者的生存率从85%降至70%（p = 0.031）。结论：MVI与肾癌的进展和预后密切相关，但在多因素分析中未发现MVI是局限性肾癌的独立预后因素。我们的结论是，MVI也应该与肿瘤分级一起评估，以预测局部RCC患者的预后。版权所有（C）2000 S. Karger AG.巴塞尔。
Objectives: The treatment of localized and even advanced renal cell carcinoma (RCC) is radical nephrectomy. However, 30% of these patients progress after radical nephrectomy. Prognostic factors are needed in order to determine the course of disease in patients undergoing radical nephrectomy. The aim of this study is to study the prognostic significance of microvascular invasion (MVI) in patients who had undergone radical nephrectomy for localized RCC.Methods: Between June 1989 and February 1999, pathologic sections of the specimens from 41 patients without metastases, nodal involvement or macroscopic venous involvement were investigated for MVI.Results: MVI was observed in 17% of the patients. MVI was related to the grade of the tumor and tumor size (p = 0.032, p = 0.017). In sarcomatoid-type RCC, MVI was more common than in other histologic types (p = 0.003). After a median follow-up of 48 months, the progression rate was 29% in patients with MVI and 17% without MVI (p = 0.001). Median progression time was 3 months in those with MVI and 41 months with no MVI (p = 0.01). The survival rate decreased from 85 to 70% in patients with MVI during a median follow-up of 48 months (p = 0.031). In multivariate analysis, MVI was not found to be an independent prognostic factor.Conclusion: Although MVI is closely related to progression and prognosis, in multivariate analysis it was not found to be an independent prognostic factor in localized RCC. We conclude that MVI should also be evaluated together with tumor grade in predicting the prognosis of patients with localized RCC. Copyright (C) 2000 S. Karger AG. Basel.