Prognostic value of TNM stage and tumor necrosis for renal cell carcinoma

Our objective was to assess the value of tumor necrosis and other factors for predicting the outcome of renal cell carcinoma (RCC). Our study comprised 328 RCC patients who were surgically treated at this hospital between 2001 and 2006. The five-year survival data was analyzed using a Kaplan-Meier statistical analysis. The prognostic factors were evaluated with a univariate analysis using a log-rank test and multivariate analysis using the Cox proportional hazards regression method. The mean follow-up period for these patients was 46.5 months (median 45.2 months). The univariate analysis revealed that age, tumor stage, TNM stage, grade, tumor necrosis, and histological type were statistically significant prognostic factors. The multivariate analysis showed that the TNM stage and tumor necrosis were the most important predictive factors in the patients’ overall survival. In the TNM stage with and without tumor necrosis, the five-year overall survival rates in stages I + II were 80.5% and 89.2%, respectively (p = 0.115), where as the five-year survival rates in stages III + IV were 32.7% and 84.0%, respectively (p < 0.001). Collectively, our present data revealed that tumor necrosis was an important predictive factor for survival in advanced stage RCC. In conclusion, both the TNM stage and tumor necrosis provided the most important prognostic factors of survival in RCC. Tumor necrosis proved to be a poor prognostic factor in advanced RCCs.

摘要我們評估腫瘤壞死與其他相關因素是否可做為腎臟癌患者預後的預測因子。從2001年到2006年共有328位腎臟癌病患在本院接受手術。5年存活率是以Kaplan-Meier 方法分析。預測因子則是利用單變項 (Log Rank test) 與多變項 (Cox proportional hazards regression method) 方法加以分析。病患平均追蹤時間為46.5個月。單變項分析顯示年齡、腫瘤分期、TNM分期、分化程度、腫瘤壞死、組織學形態上都有意義。多變項分析則顯示TNM分期和腫瘤壞死在病患存活上最有意義。當我們把TNM分期和腫瘤壞死合併一起分析，在5年存活率上，stage I+II合併腫瘤有無壞死分別為80.5%與89.2% (p = 0.115)，stage III+IV合併腫瘤有無壞死分別為32.7%與84.0% (p < 0.001)。研究顯示，腫瘤壞死在腎臟癌併有局部侵犯或遠端轉移特別有意義。總結來說，TNM分期和腫瘤壞死在腎臟癌病患存活上是最重要預測因子。特別地，在較侵犯性腎臟癌的病患，腫瘤壞死的現象代表較不好的預後。