T1b º´±âÀÇ ½Å¼¼Æ÷¾Ï¿¡¼ ¼ö¼ú ÈÄ ¿¹Èĸ¦ ¿¹ÃøÇÒ ¼ö ÀÖ´Â ÀÓ»ó ¹× º´¸®ÇÐÀû ÀÎÀÚ¿¡ ´ëÇÑ ¿¬±¸
Clinicopathological factors for the prediction of prognosis after nephrectomy in pT1b renal cell carcinoma
ÃæºÏÀÇ´ëÇмúÁö 2014³â 24±Ç 1È£ p.1 ~ p.11
¿À½Â¿ë(Oh Seung-Yong) - ÃæºÏ´ëÇб³ ÀÇÇÐÀü¹®´ëÇпø
±è¿µ¿ø(Kim Young-Won) - ÃæºÏ´ëÇб³ ÀÇ°ú´ëÇÐ ºñ´¢±â°úÇб³½Ç
À±ÇüÀ±(Yoon Hyung-Yoon) - ÃæºÏ´ëÇб³ ÀÇ°ú´ëÇÐ ºñ´¢±â°úÇб³½Ç
¼¼ºÇÊ(Seo Sung-Pil) - ÃæºÏ´ëÇб³ ÀÇ°ú´ëÇÐ ºñ´¢±â°úÇб³½Ç
ÀÌ»ó±Ù(Lee Sang-Keun) - ÃæºÏ´ëÇб³ ÀÇ°ú´ëÇÐ ºñ´¢±â°úÇб³½Ç
±è¿øÅÂ(Kim Won-Tae) - ÃæºÏ´ëÇб³ ÀÇ°ú´ëÇÐ ºñ´¢±â°úÇб³½Ç
À±¼®Áß(Yun Seok-Joong) - ÃæºÏ´ëÇб³ ÀÇ°ú´ëÇÐ ºñ´¢±â°úÇб³½Ç
ÀÌ»óö(Lee Sang-Cheol) - ÃæºÏ´ëÇб³ ÀÇ°ú´ëÇÐ ºñ´¢±â°úÇб³½Ç
±è¿øÀç(Kim Wun-Jae) - ÃæºÏ´ëÇб³ ÀÇ°ú´ëÇÐ ºñ´¢±â°úÇб³½Ç
±è¿ëÁØ(Kim Yong-June) - ÃæºÏ´ëÇб³ ÀÇ°ú´ëÇÐ ºñ´¢±â°úÇб³½Ç
Abstract
¿¬±¸¸ñÀû: T1º´±âÀÇ ±¹¼Ò½Å¼¼Æ÷¾Ï(localized clear-cell renal cell carcinoma)Àº ±ÙÄ¡Àû½ÅÀûÃâ¼úÀ̳ª ºÎºÐ½ÅÀýÁ¦¼úÀÌ Ç¥ÁØÄ¡·áÀÌ¸ç ¼ö¼ú ÈÄ Å¸ º´±â¿¡ ºñÇØ ¾çÈ£ÇÑ ¿¹Èĸ¦ º¸ÀδÙ. ÇÏÁö¸¸, ¸¹Àº ¼öÀÇ È¯ÀÚ¿¡¼ ÃßÀû°üÂû Áß Àç¹ß ¹× »ç¸ÁÀÌ ¹ß»ýÇϴµ¥, ÀÌ´Â T1b º´±â¿¡¼ ´õ ³ô°Ô º¸°íµÇ°í ÀÖ´Ù. º» ¿¬±¸¿¡¼´Â ±¹¼Ò½Å¼¼Æ÷¾Ï Áß T1b º´±âÀÇ ½Å¼¼Æ÷¾Ï¿¡¼ Ç¥ÁØÀû Ä¡·á ÈÄ È¯ÀÚÀÇ ¿¹ÈÄ¿¡ ¿µÇâÀ» ÁÖ´Â ÀÓ»ó ¹× º´¸®ÇÐÀû ÀÎÀÚ¿¡ ´ëÇÏ¿© ¾Ë¾Æº¸°íÀÚ ÇÏ¿´´Ù.
´ë»ó ¹× ¹æ¹ý: 1999³âºÎÅÍ 2011³â ±îÁö 5°³ ±â°ü¿¡¼ ±ÙÄ¡Àû½ÅÀûÃâ¼úÀ̳ª ºÎºÐ½ÅÁ¦¼úÀ» ½ÃÇà ¹ÞÀº 3567¸íÀÇ ±¹¼Ò½Å¼¼Æ÷¾Ï ȯÀÚµé Áß º´¸®ÇÐÀû º´±â°¡ T1b·Î È®Áø µÈ 702¸íÀ» ´ë»óÀ¸·Î ÇÏ¿´´Ù. À̵é ȯÀÚ°¡ °¡Áö´Â ÀÓ»ó ¹× º´¸®ÇÐÀû Ư¼º [¿¬·É, ¼ºº°, °íÇ÷¾Ð, ´ç´¢, ºñ¸¸µµ, European Cooperative Oncology Group(ECOG) ¼öÇ൵, Áõ»óÀ¯¹«, ¼ö¼ú¹æ¹ý, Á¾¾çÅ©±â, ºÐȵµ, Á¶Á÷ÇÐÀû ÇüÅ µî]À» ÀÌ¿ëÇÏ¿© ȯÀÚÀÇ ¿¹ÈÄ [¹«Àç¹ß»ýÁ¸À²(relapse-free survival), ¾ÏƯÀÌ»ýÁ¸À²(cancer-specific survival) ¹× Àüü»ýÁ¸À²(overall survival)]¿¡ ¿µÇâÀ» ¹ÌÄ¡´Â ÀÎÀÚ¿¡ ´ëÇÏ¿© ´Ù¾çÇÑ ¹æ¹ýÀ¸·Î ºñ±³ºÐ¼® ÇÏ¿´´Ù.
°á°ú: ÃßÀû °üÂû ±â°£Àº 34.0°³¿ù (Áß¾Ó°ª, 0-152°³¿ù)À̾úÀ¸¸ç, ÀÌ ±â°£ Áß Àç¹ß, »ç¸Á ¹× ¾ÏƯÀÌ»ç¸ÁÀº °¢°¢ 72·Ê (10.3%), 57·Ê (8.1%) ¹× 24·Ê (3.4%)¿¡¼ ¹ß»ýÇÏ¿´´Ù. ´Üº¯·® ¹× ´Ùº¯·® Cox ºñ·ÊÀ§Çèȸ±ÍºÐ¼®¿¡¼ ´Ù¾çÇÑ ÀÎÀÚµéÀÌ ¹«Àç¹ß»ýÁ¸À²(´ç´¢ À¯¹«, Á¾¾çÅ©±â ¹× Fuhrmanµî±Þ), ¾ÏƯÀÌ »ýÁ¸À²(³ªÀÌ, üÁú·®Áö¼ö, ´ç´¢ À¯¹«, Á¾¾çÅ©±â) ¹× Àüü»ýÁ¸À²(³ªÀÌ, üÁú·®Áö¼ö, ECOG ¼öÇ൵, Á¾¾çÅ©±â)¿¡ ¿µÇâÀ» ÁÙ ¼ö ÀÖ´Â µ¶¸³Àû ¿¹ÈÄÀÎÀÚ¿´´Ù.
°á·Ð: º» ¿¬±¸°á°ú ±¹¼Ò½Å¼¼Æ÷¾ÏÀÇ ¿¹Èĸ¦ ¿¹ÃøÇÒ ¼ö ÀÖ´Â ´Ù¾çÇÑ ÀÓ»ó ¹× º´¸®ÇÐÀû ÀÎÀÚ¸¦ È®ÀÎ ÇÒ ¼ö ÀÖ¾ú´Ù. ÀÌ·¯ÇÑ À§ÇèÀÎÀÚ¸¦ °¡Áö°í Àִ ȯÀÚ´Â º¸´Ù Àû±ØÀûÀÎ ÃßÀû°üÂûÀ» ÅëÇÏ¿© Àç¹ßÀ» Á¶±â¿¡ ¹ß°ßÇÑ´Ù¸é À̵éÀÇ »ýÁ¸À² Çâ»ó¿¡ ¸¹Àº ±â¿©¸¦ ÇÒ ¼ö ÀÖÀ» °ÍÀ¸·Î »ý°¢ÇÑ´Ù.
Background: In stage T1 localized clear-cell renal cell carcinoma (RCC), radical nephrectomy (RN) or partial nephrectomy (PN) was regarded as a golden standard treatment, it had favorable outcomes after treatment. However, during follow up period, recurrences or deaths in stage T1b RCC occurred more frequently than those of in stage T1a RCC. The aim of the present study was to evaluate clinicopathological factors which were related with prognosis in T1b RCC patients.
Materials and Methods: Between 1999 and 2011, 3567 patients with RCC underwent RN or PN at 5 institutions in Korea. Of these, we evaluated 702 patients with pathologically confirmed stage T1b RCC. To estimate the clinicopathologic predictive factors [age, sex, diabetes mellitus (DM), hypertension, body mass index (BMI), European Cooperative Oncology Group performance score (ECOG-PS), the presence of symptoms, tumor size and grade, etc] for prognosis [recurrence-free survival (RFS), cancer-specific survival (CSS) and Overall survival (OS)], univariate and multivariate analyses were utilized. Kaplan-Meier method was applied to estimate survival function.
Results: Median follow-up period was 34.0 months (range 0-152 months). Recurrence, death and cancer-specific death were observed in 10.3% (72/702), 8.1% (57/702) and 3.4% (24/702), respectively. Univariate and multivariate analyses revealed that various factors were independent predictive factors for RFS (DM, tumor size, Fuhrman grade), CSS (age, BMI, DM, tumor size) and OS (age, BMI, ECOG-PS, tumor size).
Conclusions: This study reveals that various clinicopathological factors are independent predictive factors for prognosis in localized RCC. Our findings suggest that early detection of recurrence via active follow-up in T1b RCC patients with high risk factors after surgery will contribute for the improvements of survival.
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±¹¼Ò½Å¼¼Æ÷¾Ï, T1º´±â, »ýÁ¸À², ¿¹ÈÄ
renal cell carcinoma, prognosis, stage T1b, survival
KMID :
0390320140240010001
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