Prognostic Factors Influencing Long-Term Survival of Patients Undergoing Nephron-Sparing Surgery for Nonmetastatic Renal-Cell Carcinoma (RCC) with Imperative Indications

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• 作者：Axel Haferkamp (1)
  Martin Kurosch (1)
  Maria Pritsch (2)
  Gencay Hatiboglu (1)
  Stephan Macher-Goeppinger (3)
  Jesco Pfitzenmaier (1)
  Sascha Pahernik (1)
  Nina Wagener (1)
  Markus Hohenfellner (1)
  
• 刊名：Annals of Surgical Oncology
• 出版年：2010
• 出版时间：February 2010
• 年：2010
• 卷：17
• 期：2
• 页码：544-551
• 全文大小：278KB
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• 作者单位：Axel Haferkamp (1)
  Martin Kurosch (1)
  Maria Pritsch (2)
  Gencay Hatiboglu (1)
  Stephan Macher-Goeppinger (3)
  Jesco Pfitzenmaier (1)
  Sascha Pahernik (1)
  Nina Wagener (1)
  Markus Hohenfellner (1)
  
  1. Department of Urology, University of Heidelberg, Heidelberg, Germany
  2. Department of Medical Biometry, University of Heidelberg, Heidelberg, Germany
  3. Department of Pathology, University of Heidelberg, Heidelberg, Germany
  

文摘

Background We assessed the effect of T stage, Fuhrman’s grade, multifocality, bilaterality, positive surgical margins, and synchronism of bilateral tumors on cancer-specific survival of patients with nonmetastatic renal-cell carcinoma (RCC) undergoing nephron-sparing surgery for imperative indications. Methods We retrospectively analyzed 168 patients who underwent nephron-sparing surgery for imperative RCC indications between 1974 and 2002. A total of 85 patients had bilateral RCCs; in 27 patients, the tumors were multifocal. Multivariate Cox proportional hazards models were fitted to assess the features associated with cancer-specific survival. Results The median follow-up was 99?months (range, 2-26?months). Patients were followed until January 2008. A total of 52 patients died of their cancer during follow-up. Multivariate analyses of the total group only revealed Fuhrman’s grade 3 (hazard ratio [HR] 2.94) and bilateral occurrence of RCC (HR 1.82) as independent prognostic factors. In a subgroup analysis of patients with bilateral occurrence of RCC, we observed a tendency toward positive surgical margins (HR 2.89, P?=?0.08) being another negative prognostic factor. There was no difference in cancer-specific survival between patients with synchronous and metachronous bilateral RCC presence (HR 1.08). Conclusions Fuhrman’s grade 3 and bilateral occurrence of RCC were the only statistically significant prognostic factors for cancer-specific survival in patients undergoing nephron-sparing surgery for imperative indications for nonmetastatic RCC. The presence of sporadic multifocal tumors and the synchronous occurrence of bilateral tumors have no influence on cancer-specific survival, while positive surgical margins may have an impact in the subset of patients with bilateral RCC.