局部侵犯性腎細胞癌疾病進展之預後因子

林祖丞¹、蘇世桓^1,4、黃文冠^2,4、陳東藝^3,4、邵翊紘^1,4、馮思中^1,4、謝明里^1,4、莊正鏗^1,4

林口長庚紀念醫院 外科部 泌尿科¹，內科部 腫瘤科²，內科部 心臟血管內科³ ; 長庚大學 醫學系⁴

Prognostic Factors of Disease Progression in Patients with Locally Advanced Renal Cell Carcinoma

Tsu-Chen Lin^1,†, Shih-Huan Su^1,4,†, Wen-Kuan Huang^2,4, Dong-Yi Chen^3,4, I-Hung Shao^1,4, See-Tong Pang^1,4, Ming-Li Hsieh^1,4,*, Cheng-Keng Chuang^1,4,*

Division of Urology, Department of Surgery¹, Division of Hematology/Oncology, Department of Internal Medicine² and Division of Cardiology, Department of Internal Medicine³, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan; College of Medicine, Chang Gung University, Taoyuan City, Taiwan⁴

† These authors contributed equally to this work.

* Co-corresponding Author

Purpose: We aimed to evaluate possible predictive factors for disease progression in locally advanced renal cell carcinoma (RCC) and elucidate the possible need for adjuvant therapies in this group of patients.

Materials and Methods: A retrospective study was performed at the Linkou Chang Gung Memorial Hospital in Taiwan. Patients with kidney tumors who visited our institution for treatment between January 1, 2010 and December 31, 2018 were included in the primary screening. Patients with a tumor-node-metastasis stage of T3-4N0M0 and T1-4N1M0, according to the seventh edition of the American Joint Committee on Cancer, who underwent curative surgery for RCC at our institution were included in the study. The primary outcome analyzed was the possible predictive clinical variables of disease-free survival (DFS) in patients with locally advanced RCC who received curative treatment. The secondary outcome analyzed was the overall survival (OS) of patients with locally advanced RCC who received curative treatment.

Results: A total of 116 patients with locally advanced RCC who received curative treatment at our institution were included in the analysis. Disease progression was noted in 48.3% of the patients. The median DFS was 41.5 months (95% confidence interval [CI]: 34.9-46.6 months). Mortality occurred in 37.1% of the patients. The median OS was 52.9 months (95% CI: 49.0-60.4 months). After multivariate analyses of possible predictive factors, a higher Fuhrman grade, upper pole tumors, and hemoglobin (Hb) levels lower than the normal limit were statistically associated with a poorer DFS.

Conclusion: A higher Fuhrman grade, upper pole involvement of the tumor, and Hb levels lower than the normal limit were associated with a poorer DFS in patients with locally advanced RCC who underwent curative surgery.