Abstract：Objective: To explore the related risk factors of recurrence and metastasis of clear cell renal cell carcinoma (ccRCC) after partial nephrectomy (PN). Methods: We retrospectively analyzed the clinicopathological data and follow-up results of 1 742 sporadic unilateral ccRCC patients who underwent PN in Urology Department of PLA General Hospital from January 2006 to December 2015, and the related factors of post-operative recurrence and metastasis were obtained by univariate and multivariate analysis. Results: The patients were followed up for 3.1-120.7 months with the median follow-up time of 32.4 months (mean 36.3 months). Thirty-three patients had recurrence (1.9%). Univariate analysis showed that Fuhrman grade (HR=4.476, 95% CI=1.717-11.672, P=0.002), tumor necrosis (HR=5.728, 95% CI=2.478-13.241, P<0.001) and sarcomatoid differenciation (HR=29.636, 95% CI=3.991-220.062, P=0.001) had significant effects on the recurrence-free survival of ccRCC patients after PN. Multivariate analysis also revealed that Fuhrman grade (HR=3.223, 95% CI=1.161-8.946, P=0.025), tumor necrosis (HR=5.150, 95% CI=2.195-12.081, P<0.001) and sarcomatoid differenciation (HR=16.321, 95% CI=1.973-134.992, P=0.01) were independent factors of recurrence-free survival of ccRCC patients after PN. Conclusions: Fuhrman grade, tumor necrosis, and sarcomatoid differenciation are related risk factors for recurrence of ccRCC patients after PN.
[1] Rini BI, SC Campbell, B Escudier. Renal cell carcinoma. Lancet, 2009,373(9669):1119-1132. [2] Ljungberg B, Bensalah K, Canfield S, et al. EAU guidelines on renal cell carcinoma: 2014 update. Eur Urol, 2015,67(5):913-924. [3] Patard JJ, Shvarts O, Lam JS, et al. Safety and efficacy of partial nephrectomy for all T1 tumors based on an international multicenter experience. J Urol, 2004,171(6 Pt 1):2181-2185, quiz 2435. [4] Peycelon M, Hupertan V, Comperat, et al. Long-term outcomes after nephron sparing surgery for renal cell carcinoma larger than 4 cm. J Urol,2009,181(1):35-41. [5] Becker F, Roos FC, Janssen M, et al. Short-term functional and oncologic outcomes of nephron-sparing surgery for renal tumours >/= 7 cm. Eur Urol, 2011,59(6):931-937. [6] Huang WC, Elkin EB, Levey AS, et al. Partial nephrectomy versus radical nephrectomy in patients with small renal tumors is there a difference in mortality and cardiovascular outcomes? J Urol, 2009,181(1):55-61; discussion 61-62. [7] Zini L, Patard JJ, Capitanio U, et al. Cancer-specific and non-cancer-related mortality rates in European patients with T1a and T1b renal cell carcinoma. BJU Int, 2009,103(7):894-898. [8] Crispen PL, Boorjian SA, Lohse CM, et al. Outcomes following partial nephrectomy by tumor size. J Urol, 2008,180(5):1912-1917. [9] Leibovich BC, Blute ML, Cheville JC, et al. Prediction of progression after radical nephrectomy for patients with clear cell renal cell carcinoma: a stratification tool for prospective clinical trials. Cancer, 2003,97(7):1663-1671. [10] Frank I, Blute ML, Cheville JC, et al. An outcome prediction model for patients with clear cell renal cell carcinoma treated with radical nephrectomy based on tumor stage, size, grade and necrosis: the SSIGN score. J Urol, 2002,168(6):2395-2400. [11] Uzzo RG, Novick AC. Nephron sparing surgery for renal tumors: indications, techniques and outcomes. J Urol, 2001,166(1):6-18. [12] Minardi D, Lucarini G, Mazzucchelli R, et al. Prognostic role of Fuhrman grade and vascular endothelial growth factor in pT1a clear cell carcinoma in partial nephrectomy specimens. J Urol, 2005,174(4 Pt 1):1208-1212. [13] Minervini A, Lilas L, Minervini R, et al. Prognostic value of nuclear grading in patients with intracapsular (pT1-pT2) renal cell carcinoma. Long-term analysis in 213 patients. Cancer, 2002,94(10):2590-2595. [14] Chang YH, Chuang CK, Pang ST, et al. Prognostic value of TNM stage and tumor necrosis for renal cell carcinoma. Kaohsiung J Med Sci, 2011,27(2):59-63. [15] Sengupta S, Lohse CM, Leibovich BC, et al. Histologic coagulative tumor necrosis as a prognostic indicator of renal cell carcinoma aggressiveness. Cancer, 2005,104(3):511-520. [16] Pichler M, Hutterer GC, Chromecki TF, et al. Histologic tumor necrosis is an independent prognostic indicator for clear cell and papillary renal cell carcinoma. Am J Clin Pathol, 2012,137(2):283-289. [17] Cheville JC, Lohse CM, Zincke H, et al. Sarcomatoid renal cell carcinoma: an examination of underlying histologic subtype and an analysis of associations with patient outcome. Am J Surg Pathol, 2004,28(4):435-441. [18] Kwak C, Park YH, Jeong CW, et al. Sarcomatoid differentiation as a prognostic factor for immunotherapy in metastatic renal cell carcinoma. J Surg Oncol, 2007,95(4):317-323. [19] Hafez KS, Fergany AF, Novick AC. Nephron sparing surgery for localized renal cell carcinoma: impact of tumor size on patient survival, tumor recurrence and TNM staging. J Urol, 1999,162(6):1930-1933. [20] Marszalek M, Carini M, Chlosta P, et al. Positive surgical margins after nephron-sparing surgery. Eur Urol, 2012,61(4):757-763.
