임상병기 T1 신세포암의 수술 후 병리학적 병기 T3a로 악화 시 예후 및 그와 관련된 인자 분석

Abstract

Purpose: To evaluate the prognosis of pT3a upstaging from cT1 renal cell carcinoma, and to compare the outcomes of partial or radical nephrectomy in cases of pT3a upstaging. Materials and Methods: We reviewed the records of patients who underwent partial or radical nephrectomy for cT1 at our center between January 2001 and October 2013. We compared the 2-year recurrence-free survivals for cases with pT1 or pT3a upstaging, and for partial or radical nephrectomy in cases with pT3a upstaging. Clinicopathological parameters were analyzed in univariate and multivariate analyses to evaluate their associations with upstaging. Results: Among the 1,009 eligible patients, 987 patients were included in the analysis. The mean follow-up was 48.5 months. The 2-year recurrence-free survival was worse in the pT3a upstaging group, compared to the pT1 group (87.3% vs. 99.3%

p < 0.001). Partial nephrectomy and radical nephrectomy provided comparable 2-year recurrence-free survivals (88.2% vs. 83.7%

p = 0.251). The multivariate analysis revealed that upstaging was associated with old age, cT1b stage, clinical symptoms, and a high Fuhrman grade. Conclusions: Pathological T3a upstaging of cT1 renal cell carcinoma was associated with a poorer prognosis, compared to pT1 disease. However, the surgical technique (radical or partial nephrectomy) did not affect the recurrence rate. Therefore, clinicians should select the treatment method based on the clinical stage, and consider the pathological stage during the follow-up.