Evaluation of Tumor Pseudocapsule Status and its Prognostic Significance in Renal Cell Carcinoma
Evaluation of Tumor Pseudocapsule Status and its Prognostic Significance in Renal Cell Carcinoma
复制标题
肾细胞癌中肿瘤假包膜状态的评估及其预后意义
DOI：
10.1016/j.juro.2017.10.043
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发表时间：
2018-04-01
影响因子：
6.6
通讯作者：
Guo, Jianming
中科院分区：
文献类型：
--
作者：
Xi, Wei;Wang, Jiajun;Guo, Jianming
目的：我们确定是否肿瘤的假包膜状态，包括癌症的浸润程度和缺乏一个假包膜，具有预后价值在renal cell carcinoma.Materials和Methods：我们回顾性分析了1,577例不同阶段的肾细胞癌患者在我们的机构进行肾切除术，其中1,307（82.9%）有资格进行分析。所呈现的假囊被分类为0级-完全完整，1级-仅涉及和2级-穿透。我们使用Kaplan-Meier方法和考克斯回归模型研究了总体和无进展生存率。结果：在1,307例患者中，1,244例（95.2%）出现假包膜，其中350例（28.1%）、643例（51.7%）和251例（20.2%）分别出现0级、1级和2级假包膜浸润程度。Kaplan-Meier曲线显示，随着浸润程度的增加和假包膜缺失，总体生存率和无进展生存率均显著下降。在多变量分析中，我们确定了与0级假包膜相比，2级假包膜（HR 2.12和2.66，均p < 0.0001）和缺乏假包膜（HR 1.95，p = 0.0248和HR 2.54，p = 0.0007）的显著总体和无进展生存期损害。仅检测到无进展生存期的统计学风险从1级到0级的变化。pseudocapsule状态的预后价值表现为一个更高的HR在个人与本地化renal cell carcinoma.Conclusions多变量分析：我们的研究结果表明，pseudocapsule状态在肾细胞癌具有良好的预后意义。缺乏假包膜肯定对患者结局有显著不良影响。使用和成本的可及性使得假囊状态成为临床实践中潜在的成本效益参数。
Purpose: We determined whether tumor pseudocapsule status, including the extent of invasion by cancer and lack of a pseudocapsule, has prognostic value in renal cell carcinoma.Materials and Methods: We retrospectively reviewed the records of 1,577 patients with different stages of renal cell carcinoma who underwent nephrectomy at our institution, of whom 1,307 (82.9%) were eligible for analysis. Presented pseudocapsules were classified as grade 0-completely intact, grade 1-merely involved and grade 2-penetrated. We studied overall and progression-free survival using the Kaplan-Meier method and a Cox regression model.Results: Of the 1,307 patients 1,244 (95.2%) presented with a pseudocapsule, including 350 (28.1%), 643 (51.7%) and 251 (20.2%) with a grade 0, 1 and 2 pseudocapsule invasion extent, respectively. Kaplan-Meier curves revealed great losses in overall and progression-free survival for an increased extent of invasion and pseudocapsule absence. On multivariate analyses we identified significant overall and progression-free survival harms for grade 2 pseudocapsules (HR 2.12 and 2.66, each p < 0.0001) and lack of a pseudocapsule (HR 1.95, p = 0.0248 and HR 2.54, p = 0.0007, respectively) compared to grade 0 pseudocapsules. A change in statistical risk from grade 1 to 0 was only detected for progression-free survival. The prognostic value of pseudocapsule status was shown by a higher HR on multivariable analyses in individuals with localized renal cell carcinoma.Conclusions: Our findings suggest that pseudocapsule status has good prognostic implications in renal cell carcinoma. Lack of a pseudocapsule certainly had a remarkably adverse impact on the patient outcome. Accessibility in use and cost makes pseudocapsule status a potential cost-effective parameter in clinical practice.