ISSN:
1437-7772
Schlagwort(e):
Key words Renal cell carcinoma
;
Recurrence
;
Surveillance protocol
Quelle:
Springer Online Journal Archives 1860-2000
Thema:
Medizin
Notizen:
Abstract Background. To reduce unnecessary tests for patients with renal cell carcinoma (RCC) at low risk of metastasis, we designed a postoperative surveillance protocol for N0M0 RCC, based on the features of recurrence. Methods. Of 462 N0M0 RCC patients who underwent radical nephrectomy, 180 patients (39%) showed recurrence. We stratified these patients according to pathologi-cal T-stage (pT-stage) with consideration given to the pathological grade of malignancy (grade). A surveillance protocol was designed based on calculated disease-free survival rates. Results. The median time until recurrence was 36 months (range, 1 to 228 months), and 78.3% of all patients, recurrence was diagnosed within 5 years. The rate of recurrence increased in accordance with increased pT-stage: pT1a, 9.9% (10/101); pT1b, 29.8% (39/131); pT2, 41.7% (20/48); pT3a, 58.8% (60/102); pT3b, 60.9% (42/69); pT3c, 71.4% (5/7); pT4, 100% (4/4). Significant differences in disease-free survival rates were observed among the patients at all pT-stages, except for pT1b vs pT2, pT2 vs pT3a, pT3a vs pT3b, and pT3c vs pT4. Basically, a 5-year follow-up was conducted, except for the patients with pT1b (grade 1 + 2), pT2 (grade 1 + 2), pT3a (grade 1, 3), and pT3b (grade 1 + 2), who showed recurrence more than 5 years postoperatively. Conclusion. We conclude that our surveillance protocol for N0M0 RCC after nephrectomy, based on pT-stage and grade, is to some extent a reasonable guideline. However, a further survey of prognostic factors for RCC is necessary, because of the difficulty in predicting recurrence in patients with a low pT-stage and because of the presence of patients with late recurrence.
Materialart:
Digitale Medien
URL:
http://dx.doi.org/10.1007/PL00012053
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