腎細胞癌淋巴侵犯與存活率之相關分析研究：討論現行TMN分級之修正
陳思遠、楊聿寬、劉忠一、林柏宏、甘弘成、邵翊紘、張英勛、莊正鏗、馮思中、虞凱傑
林口長庚紀念醫院 泌尿科、長庚大學 醫學院
Pathological node-positive renal cell carcinoma is associated with worse survival outcome: A recall for TMN staging revision
SY Chen, YK Yang, CY Liu, PH Lin, HC Kan, IH Shao, YH Chang, CK Chuang, ST Pang, KJ Yu
Division of Urology, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan.
Purpose: Previous studies had shown renal cell carcinoma patients staged III with positive nodal invasion has similar survival outcomes with stage IV disease rather than stage III patients without. The study provides new evidence which supported that stage III pathologic nodal disease should be reclassified as stage IV.
Materials and Methods:Data of 397 patients with RCC within a single center from 2001 to 2018 was retrospectively obtained from the Chang Gung Research Database. A total of 138 patients with T3N0M0, 29 with T3cN1M0, 104 patients with N0M, and 126 patients with N1M1 were collected in the study. Overall survival were calculated and compared between the 4 groups using the Kaplan–Meier methods.
Results:Stage III patient with node positive disease, the pT3pN1M0 group had OS of w 2.58 years(1.31-3.85), which was worse than 9.67(7.69-11.65) years of those without (T3pN0M0 group, P < 0.005). However, no significant difference was observed in OS between the pT3pN1M0 and N0M1 groups (P = 0.72), with OS of 2.58 (1.31–3.85) and 2.50 (1.85–3.15) years, respectively.
Conclusions:Pathological LN invasion in patients with stage III RCC resulted in OS closer to that of patients with stage IV cancer than to that of patients with stage III cancer without LN involvement. The results supported the hypothesis that LN invasion may be reclassified as a stage IV disease by differentiating the survival outcomes in locally advanced RCC.