临床分期T1-3N1-2M0肾细胞癌患者临床分析：单中心研究(英文)

Patient outcome and prognostic factors of renal cell carcinoma in clinical stage T1-3N1-2M0:a single-institution analysis

分析临床分期为T1-3N1-2M0肾癌的临床病理及预后资料,探讨其生物学行为特点。方法 1988年至2008年间我院共收治无远处转移肾癌并行开放性肾癌根治术的患者531例,其中42例伴淋巴结转移患者顺利完成了手术,对其临床病理及预后资料进行回顾性分析。结果 42例患者中,19.0%为T1期,21.4%为T2期,59.5%为T3期;42.9%为N1期和57.1%为N2期。末次随访30例(71.4%)出现肿瘤复发,26例(61.9%)患者死亡,83.3%(25/30)初次复发即为多发性。42例患者中位肿瘤特异生存期(CSS)和无病生存期(DFS)分别为23个月和11个月。多因素生存分析显示,病理分级(P=0.005),淋巴结分期(P=0.014)和T分期(P=0.037)是CSS的独立影响因素;术前状态(P=0.002),肿瘤大小(P=0.007),病理分级(P=0.009)和淋巴结分期(P=0.019)是DFS的独立影响因素。结论 T1-3N1-2M0期肾癌患者预后较差。淋巴结分期是T1-3N1-2M0期肾癌CSS和DFS的独立影响因素,对术中出现可疑肿大淋巴结者应行扩大的淋巴结清扫术。

Objective To report our data of patients with clinical stage T1-3N1-2M0 renal cell carcinoma（RCC） and explore the biological behavior of this malignancy.Methods A total of 531 patients with no distant metastatic RCC underwent open radical nephrectomy at our institution between 1988 and 2008,among whom 42 patients with histological nodal metastases had successful surgical tumor resection.The clinical data and outcomes of the 42 patients were analyzed.Results Of those 42 patients,19.0% had T1,21.4% had T2,and 59.5% had T3 stage tumors;42.9% had N1 and 57.1% had N2 stage tumors.Tumor recurred in 30（71.4%） patients after the surgery,and death occurred in 26（61.9%） cases at the last follow-up;among the recurrent cases,83.3%（25/30） had multiple metastases at the initial recurrence.The median cancer-specific survival（CSS） and disease-free survival（DFS） was 23 and 11 months in these cases,respectively.Multivariate analysis demonstrated that Fuhrman grade（P=0.005） ,N stage（P=0.014） and T stage（P=0.037） were the independent predictors of CSS;Eastern Cooperative Oncology Group（ECOG） performance status（PS） （P=0.002） ,tumor size（P=0.007） ,Fuhrman grade（P=0.009） and N stage（P=0.019） were the independent predictors of DFS.Conclusion Patients with T1-3N1-2M0 RCC have poor prognosis.N stage is an independent predictor of both CSS and DFS,suggesting that extended lymph node dissection should be performed when suspicious enlarged nodal disease is found during surgery.