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Abstract
Purpose
The prognostic factors of renal cell carcinoma(RCC) are well known. However, the knowledge about the behavior of the nodal and metastatic involvement is still lacking. We analyzed the prognostic factors and survival for patients with various statuses of RCCs.
Materials and Methods
We conducted a retrospective review of 1,140 patients who had RCC between 1989 and 2005. The patients with multifocal and/or cystic RCCs, bilateral RCCs, RCCs related to ESRD and von Hippel-Lindau disease or the patients who didn't undergo lymph node dissection were excluded. The patients were divided into 4 groups; the TxN0M0 (473 patients), TxN1-2M0 (31), TxN0M1 (47) and TxN1-2M1 (21) groups. Univariate and multivariate analysis were performed to identify the prognostic factors (age, the mean tumor size, the pT stage, the histological type, the nuclear grade and the presence of symptoms). The five-year cancer-specific survival (CSS) also was calculated.
Results
The five-year CSS for each group was 90.5%, 62.8%, 38.8% and 17.9%, respectively. For the TxN0M0 group, every prognostic factor had a significant impact on survival on univariate analysis. Multivariate analysis subsequently showed that the pT stage, the histological type and the nuclear grade were independent prognostic factors. For the TxN1-2M0 group, the histological type was a significant prognostic factor. Age and the pT stage were independent prognostic factors for the TxN0M1 group and the presence of symptoms was an independent prognostic factor for the TxN1-2M1 group.
Conclusions
The survival was the highest for the TxN0M0 group and it was the lowest for the TxN1-2M1 group. The survival for the TxN1-2M0 group was better than that for the TxN0M1 group. These results obtained by analyzing the prognostic factors and the five-year CSS according to the various nodal and metastatic statuses of RCC patients will provided crucial information to predict clinical progression and the survival outcomes.
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Fig. 1.
Cancer-specific survival according to the lymph node involvement or metastasis (Kaplan-Meier cancer survival curve).
Table 1.
Clinical characteristics
| Group A | Group B | Group C | Group D | p-value | |
|---|---|---|---|---|---|
| No. of patients | 473 | 31 | 47 | 21 | |
| Mean age±SD (years) | 54.1±11.3 | 52.0±17.1 | 55.3±10.9 | 53.2±14.3 | 0.652∗ |
| 0.601† Sex | |||||
| Male (%) | 339 (71.7) | 22 (71.0) | 37 (78.7) | 17 (81.0) | |
| Female (%) | 134 (28.3) | 9 (29.0) | 10 (21.3) | 4 (19.0) | |
| Mean tumor size±SD (cm) | 6.4±3.2 | 8.7±3.7 | 8.8±3.0 | 10.4±3.9 | ＜0.001∗ |
| ＜0.001† Pathological T stage (%) | |||||
| pT1a | 130 (27.5) | 4 (12.9) | 0 (0) | 0 (0) | |
| pT1b | 151 (31.9) | 3 (9.7) | 8 (17.0) | 1 (4.8) | |
| pT2 | 86 (18.2) | 5 (15.1) | 13 (27.7) | 4 (19.0) | |
| pT3a | 48 (10.1) | 6 (19.4) | 12 (25.5) | 7 (33.3) | |
| pT3b | 50 (10.6) | 11 (35.5) | 12 (25.5) | 5 (23.8) | |
| pT3c | 3 (0.6) | 0 (0) | 1 (2.1.0) | 2 (9.5) | |
| pT4 | 5 (1.1) | 2 (6.5) | 1 (2.1.0) | 2 (9.5) | |
| ＜0.001† Histological type (%) | |||||
| Conventional | 366 (82.4) | 14 (60.9) | 37 (84.1) | 11 (55.0) | |
| Papillary | 26 (5.9) | 4 (17.4) | 2 (4.5) | 5 (25.0) | |
| Chromophobe | 36 (8.1) | 0 (0) | 0 (0) | 1 (5.0) | |
| Collecting duct | 0 (0) | 0 (0) | 0 (0) | 1 (5.0) | |
| Unclassified | 16 (3.6) | 5 (21.6) | 5 (10.3) | 2 (10.0) | |
| ＜0.001† Nuclear grade (%) | |||||
| 1 | 20 (4.5) | 0 (0) | 1 (2.2) | 0 (0) | |
| 2 | 205 (46.2) | 6 (22.2) | 13 (28.3) | 1 (4.8) | |
| 3 | 177 (39.9) | 16 (59.3) | 24 (52.2) | 14 (66.7) | |
| 4 | 42 (9.5) | 5 (18.5) | 8 (17.4) | 6 (28.6) | |
| Mean follow-up±SD (months) | 57.6±38.0 | 49.5±38.7 | 25.1±19.5 | 16.1±20.6 | ＜0.001∗ |
Table 2.
Five-year cancer-specific survival for the patients with renal cell carcinoma according to lymph node involvement or metastasis
Table 3.
Multivariate analysis of the five-year cancer-specific survival for patients with renal cell carcinoma without involvement of the lymph node or other organs (multivariate Cox regression model)
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