Postoperative surveillance protocol for patients with localized and locally advanced renal cell carcinoma based on a validated prognostic nomogram and risk group stratification system
Postoperative surveillance protocol for patients with localized and locally advanced renal cell carcinoma based on a validated prognostic nomogram and risk group stratification system
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DOI：
10.1097/01.ju.0000165572.38887.da
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发表时间：
2005-08-01
影响因子：
6.6
通讯作者：
Belldegrun, AS
中科院分区：
文献类型：
--
作者：
Lam, JS;Shvarts, O;Belldegrun, AS
目的：我们基于风险组分层系统，为局限性和局部晚期肾细胞癌 (RCC) 患者制定了基于证据的术后监测方案。 材料和方法：根据加州大学洛杉矶分校综合分期系统 (UISS)，将 559 名接受局部和局部晚期肾细胞癌 (RCC) 手术的患者分为低风险 (LR)、中风险 (IR) 和高风险 (HR) 组。根据时间和部位对肿瘤复发进行识别和分类。结果：局部疾病患者的 5 年复发率低于局部晚期（淋巴结）疾病患者（27.6% vs 64%，p < 0.0001）。肾切除术后 LR、IR 和 HR 组患者的 5 年无复发率分别为 90.4%、61.8% 和 41.9% (p < 0.0001)，中位复发时间分别为 28.9、17.8 和 9.5 个月 (p < 0.0001)。 LR、IR 和 HR 组中胸部和腹部复发率分别为 75% 和 37.5%、77.4% 和 58.1%、45.2% 和 67.7%。在淋巴结阳性疾病的患者中，胸部和腹部复发率分别为 58.8% 和 76.5%。与接受根治性肾切除术的患者相比，接受部分肾切除术的患者并未表现出更高的局部或远处复发率。结论：肾细胞癌手术切除后的发病率和复发时间存在显着差异，要求对每个 UISS 风险组的患者采取独特的监测方案。 LR 组患者应随访至少 5 年，而 IR 和 HR 组患者需要更长时间的监测。 HR组患者需要更严格的腹部监测，而LR组患者应强调胸部。患有淋巴结疾病的患者也需要严格的随访。因局部疾病而接受部分肾切除术的患者可以根据相同的基于 UISS 风险组的方案进行随访。
Purpose: We created an evidence based postoperative surveillance protocol for patients with localized and locally advanced renal cell carcinoma (RCC) based on a risk group stratification system.Materials and Methods: 559 patients undergoing surgery for localized and locally advanced RCC were stratified into low risk (LR), intermediate risk (IR) and high risk (HR) groups based on the University of California-Los Angeles Integrated Staging System (UISS). Tumor recurrences were identified and categorized according to time and location.Results: Patients with localized disease had a lower 5-year recurrence rate than patients with locally advanced (nodal) disease (27.6% vs 64%, p < 0.0001). Patients in the LR, IR, and HR groups following nephrectomy demonstrated 5-year recurrence-free rates of 90.4%, 61.8%, and 41.9%, respectively (p < 0.0001), and median times to recurrence of 28.9, 17.8 and 9.5 months, respectively (p < 0.0001). Chest and abdomen recurrences comprised of 75% and 37.5%, 77.4% and 58.1%, and 45.2% and 67.7% of recurrences in the LR, IR and HR groups, respectively. In patients with node positive disease, chest and abdomen comprised of 58.8% and 76.5% of recurrences, respectively. Patients undergoing partial nephrectomy did not demonstrate a greater rate of local or distant recurrence compared with patients undergoing radical nephrectomy.Conclusions: Significant differences in incidence and time to recurrence following surgical resection for RCC mandates unique surveillance protocols for patients in each of the UISS risk groups. LR group patients should be followed for at least 5 years, whereas IR and HR group patients require longer surveillance. HR group patients require more stringent abdominal surveillance, whereas LR group patients should emphasize the chest. Patients with nodal disease also require stringent followup. Patients undergoing partial nephrectomy for localized disease can be followed according to the same UISS risk group based protocol.