单中心93例pN1期局部进展性肾癌根治术联合淋巴结清扫术的临床疗效分析

Clinical efficacy analysis of radical nephrectomy combined with lymph node dissection for 93 patients with locally advanced stage pN1 renal carcinoma in a single center

目的:探讨pN1期局部进展性肾癌行根治性肾切除术联合区域淋巴结清扫术的临床疗效。方法:收集1999年3月—2022年2月于中山大学肿瘤防治中心泌尿外科行根治性肾切除术后病理为pN1期的局部进展性肾癌患者的临床资料。应用单因素/多因素logistic回归和Kaplan-Meier生存曲线对临床数据进行分析。结果:93例pT1~4N1M0期肾癌患者,男62例,女31例,平均年龄为(47±16)岁。pT1~2期肾癌患者28例,pT3期及以上65例。术中中位清扫淋巴结数目为8.0(4.0,12.0)个,术后病理淋巴结转移中位数目为2.0(1.0,5.0)个。随访过程中51例患者出现术后肿瘤进展,其中局部复发7例,远处转移44例。中位无复发生存期(relapse free survival,RFS)为0.87(0.35,2.60)年,中位总生存时间(overall survival,OS)为2.17(1.13,4.11)年,其中1、3和5年RFS率分别为46.2%、23.7%和14.0%;1、3和5年的OS率分别为80.6%、38.7%和19.3%。肉瘤样分化和术后复发转移是生存预后的独立危险因素(P=0.003,P=0.001);术前淋巴结肿大是肾癌术后远处转移的独立危险因素(P=0.044);多组区域淋巴结转移是肾癌术后局部复发的独立危险因素(P=0.036)。结论:局部进展性肾癌伴淋巴结转移的患者术后复发转移概率高,预后差,需要密切监测随访。术前区域淋巴结肿大、原发灶肉瘤样变以及术后肿瘤进展是pN1期进展性肾癌的不良预后因素。

Objective To assess the clinical effectiveness of radical nephrectomy combined with regional lymphadenectomy in treating locally advanced renal carcinoma at pathological N1 stage.Methods Clinical data from a cohort comprising ninety-three patients diagnosed with locally advanced renal carcinoma at pathological N1 stage who underwent radical nephrectomy at Sun Yat-sen Cancer Center from March 1999 to February 2022 were retrospectively collected for analysis by using univariate/multivariate logistic regression models as well as Kaplan-Meier survival curves.Results A total of 93 patients diagnosed with pT1-4N1M0 renal carcinoma had a mean age of (47±16) years and a male-to-female ratio of 62∶31. There were 28 patients diagnosed with stage pT1-2 renal cancer, while 65 patients had advanced stages of pT3 and above. The median number of lymph nodes dissected during operation was 8.0(4.0, 12.0), and the median number of pathological lymph node metastases after operation was 2.0(1.0, 5.0). During the follow-up period, tumor progression occurred in 51 patients, including local recurrence in 7 cases and distant metastasis in 44 cases. The median relapse-free survival(RFS) was approximately 0.87 years(range from 0.35 to 2.60 years), while the median overall survival(OS) was approximately equal to 2.17 years(range from 1.13 to 4.11 years). The 1, 3 and 5-year RFS rates were 46.2%, 23.7% and 14.0%, respectively. The 1, 3 and 5-year OS rates were 80.6%, 38.7% and 19.3%, respectively.Sarcomatoid differentiation, postoperative tumor progression were identified as independent risk factors in prognosis (P=0.003, P=0.001). Preoperative lymph node enlargement was an independent risk factor in postoperative distant metastasis (P=0.044), and multi-group regional lymph node metastases were independent risk factors in postoperative local recurrence (P=0.036).Conclusion Lymph node-metastatic locally advanced renal carcinoma shows a high likelihood of postoperative recurrence and metastasis and poor postoperative prognosis, and thus requires intensive monitoring and follow-up. Preoperative regional lymph node enlargement, sarcomatoid differentiation, as well as postoperative tumor progression are significant adverse prognostic factors for stage N1 progressive renal carcinoma.