CAJ | 학술논문

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.
분석림상분기위T1-3N1-2M0신암적림상병리급예후자료,탐토기생물학행위특점.방법 1988년지2008년간아원공수치무원처전이신암병행개방성신암근치술적환자531례,기중42례반림파결전이환자순리완성료수술,대기림상병리급예후자료진행회고성분석.결과 42례환자중,19.0%위T1기,21.4%위T2기,59.5%위T3기;42.9%위N1기화57.1%위N2기.말차수방30례(71.4%)출현종류복발,26례(61.9%)환자사망,83.3%(25/30)초차복발즉위다발성.42례환자중위종류특이생존기(CSS)화무병생존기(DFS)분별위23개월화11개월.다인소생존분석현시,병리분급(P＝0.005),림파결분기(P＝0.014)화T분기(P=0.037)시CSS적독립영향인소;술전상태(P＝0.002),종류대소(P=0.007),병리분급(P=0.009)화림파결분기(P=0.019)시DFS적독립영향인소.결론 T1-3N1-2M0기신암환자예후교차.림파결분기시T1-3N1-2M0기신암CSS화DFS적독립영향인소,대술중출현가의종대림파결자응행확대적림파결청소술.
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.