Cancer UrologyCancer UrologyОнкоурология1726-97761996-1812Publishing House ABV Press144910.17650/1726-9776-2021-17-3-39-46DIAGNOSIS AND TREATMENT OF URINARY SYSTEM TUMORS. RENAL CANCERДИАГНОСТИКА И ЛЕЧЕНИЕ ОПУХОЛЕЙ МОЧЕПОЛОВОЙ СИСТЕМЫ. Рак почкиLong-term treatment outcomes of patients with non-clear cell renal cell carcinomaОтдаленные результаты лечения больных несветлоклеточным почечно-клеточным ракомMukhomedyarovaA. A.МухомедьяроваА. А.
Russian Federation

Al'bina Anatol'evna Mukhomedyarova

3 2nd Botkinskiy Proezd, Moscow 125284

Альбина Анатольевна Мухомедьярова

125284 Москва, 2-й Боткинский проезд, 3

albina_onc@mail.ruhttps://orcid.org/0000-0002-3398-4128AlekseevB. Ya.АлексеевБ. Я.
Russian Federation

3 2nd Botkinskiy Proezd, Moscow 125284; 11 Volokolamskoe Shosse, Moscow 125080

Борис Яковлевич Алексеев - заместитель генерального директора по науке, доктор медицинских наук, профессор.

125284 Москва. 2-й Боткинский проезд, 3; 125080 Москва, Волоколамское шоссе, 11

 

byalekseev@mail.ruhttps://orcid.org/0000-0002-2209-3020KalpinskiyA. S.КалпинскийА. С.
Russian Federation

3 2nd Botkinskiy Proezd, Moscow 125284

Алексей Сергеевич Калпинский - старший научный сотрудник отделения онкоурологии, кандидат медицинских наук.

125284 Москва, 2-й Боткинский проезд, 3

Dr.Kalpinskiy@gmail.comP.A. Hertzen Moscow Oncology Research Institute — branch of the National Medical Research Radiological Center, Ministry of Health of RussiaМосковский научно-исследовательский онкологический институт им. П.А. Герцена — филиал ФГБУ Национальный медицинский исследовательский центр радиологии Минздрава РоссииP.A. Hertzen Moscow Oncology Research Institute — branch of the National Medical Research Radiological Center, Ministry of Health of RussiaФГБУ Национальный медицинский исследовательский центр радиологии Минздрава РоссииMedical Institute of Continuing Education, Moscow State University of Food ProductionМедицинский институт непрерывного образования, ФГБОУ ВО Московский государственный университет пищевых производств1111202117339461806202101092021https://oncourology.abvpress.ru/oncur/article/view/1449

Objective: to analyze factors affecting relapse-free and overall survival of patients with non-metastatic non-clear cell renal cell carcinoma (nccRCC) after surgical treatment.

Materials and methods. This study included 279 (13.62 %) nccRCC patients from the database containing information on 2049 patients with localized and locally advanced renal cell carcinoma (RCC) without distant metastases who underwent surgical treatment in the Department of Urologic Oncology, P.A. Herzen Moscow Oncology Research Institute between 2002 and 2018. Gender ratio was 1.36:1 (161 men (57.7 %) and 118 women (42.3 %)). Median follow-up time was 34.5 months (range: 1-141 months). Patients had undergone either radical nephrectomy (n = 117; 41.9 %) or kidney resection (n = 160; 57.4 %) or radiofrequency thermal ablation (n = 2; 0.7 %). Standard (open) transperitoneal approach was used in 135 patients (48.4 %) patients, whereas 144 (51.6 %) patients were operated on via laparoscopic approach. Postoperative histological examination demonstrated that 110 participants (39.4 %) had chromophobe RCC, while 79 (28.3 %) and 63 (22.6 %) individuals had type 1 and type 2 papillary RCC, respectively. Twenty-seven patients were found to have rare or mixed variants of nccRCC (they were excluded from the analysis due to their relatively small number). Patients were diagnosed with the following stages of cancer: рТ1а (n = 129; 46.2 %), pT1b (n = 72; 25.8 %), рТ2а (n = 18; 6.5 %), pT2b (n = 8; 2.9 %), рТ3а (n = 31; 11.1 %), pT3b (n = 4; 1.4 %), рТ4 (n = 1; 0,4 %), and pN+ (n = 16; 5.7 %).

Results and conclusion. 13 patients (4.7 %) were diagnosed progressive disease; 9 patients (3.2 %) died due to nccRCC progression. The highest relapse-free and overall survival rates were registered in the patients with type 1 papillary RCC and chromophobe RCC.

Spearman's correlation analysis showed a significant correlation between the risk of disease progression and tumor size (R = 0.23; p <0.0001), pT stage (R = 0.24; p = 0.0001), vascular invasion (R = 0.36; p <0.0001), pN+ stage (R = 0.4; p <0.0001), surgical resection margin (R = 0.5; p <0.0001), histological variant (R = 0.14; p = 0.02), and Furman differentiation grade (R = 0.16; p = 0.02). The following factors were found to have an impact on relapse-free survival according to multivariate Cox regression: presence of necrosis (p = 0.04), pT stage (p = 0.03), and vascular invasion (p = 0.08), although the last variable failed to reach statistical significance. Cancer-specific survival was significantly affected by pT stage (p = 0.01) and Furman differentiation grade (p = 0.04). None of the factors demonstrated significant associations with overall survival. Thus, the most significant prognostic factor affecting relapse-free, overall, and cancer-specific survival in nccRCC patients was the pT stage (p <0.05).

Цель исследования - изучение факторов прогноза безрецидивной и общей выживаемости больных неметастатическим несветлоклеточным почечно-клеточным раком (нсПКР) после хирургического лечения.

Материалы и методы. В исследование вошли 279 (13,62 %) пациентов с нсПКР из базы данных, включающей 2049 пациентов с локализованным и местно-распространенным почечно-клеточным раком (ПКР) без отдаленных метастазов, которым в отделении онкоурологии МНИОИ им. П.А. Герцена выполнили хирургическое лечение в период с 2002 по 2018 г. Соотношение мужчин и женщин составило 1,36:1; 161 (57,7 %) мужчина и 118 (42,3 %) женщин. Медиана времени наблюдения -34,5 (1-141) мес. Пациентам выполнили хирургическое вмешательство в объеме радикальной нефрэктомии (n = 117; 41,9 %) или резекции почки (n = 160; 57,4 %), радиочастотная термоаблация проведена 2 (0,7 %) больным. Стандартным (открытым) чрезбрюшинным доступом выполнили операцию 135 (48,4 %) больным, лапароскопическим доступом - 144 (51,6 %). По данным послеоперационного гистологического исследования хромофобный ПКР выявлен у 110 (39,4 %) больных, папиллярный ПКР 1-го типа - у 79 (28,3 %), папиллярный ПКР 2-го типа - у 63 (22,6 %); у 27 больных диагностировали редкие и смешанные виды нсПКР (с учетом небольшого числа случаев из анализа они исключены). Стадия рТ 1а установлена у 129 (46,2 %) пациентов, рТ1Ь - у 72 (25,8 %), рТ2а - у 18 (6,5 %), рТ2Ь - у 8 (2,9 %), рТ3а - у 31 (11,1 %), рТ3Ь -у 4 (1,4 %), рТ4 - у 1 (0,4 %), рN+ - у 16 (5,7 %).

Результаты и заключение. Прогрессирование заболевания диагностировали у 13 (4,7 %) больных, умерли от прогрессирования нсПКР 9 (3,2 %) больных. По данным выполненного анализа наибольшие безрецидивную и общую выживаемость зарегистрировали в группах папиллярного ПКР 1-го типа и хромофобного ПКР.

По данным проведенного корреляционного анализа по Спирмену в группе нсПКР выявлена статистически достоверная корреляция вероятности прогрессирования с размером опухоли (R = 0,23; р <0,0001), патологоанатомической стадией рТ (R = 0,24; р = 0,0001), сосудистой инвазией (R = 0,36; р <0,0001), стадией рN+ (R = 0,4; р <0,0001), хирургическим краем резекции (R = 0,5; р <0,0001), гистологическим вариантом (R = 0,14; р = 0,02) и степенью дифференцировки по Фурману (R = 0,16; р = 0,02). По данным многофакторного регрессионного анализа Кокса на безрецидивную выживаемость оказывали влияние наличие некроза (р = 0,04), стадия pT (р = 0,03), также отмечалась тенденция влияния сосудистой инвазии (р = 0,08). На опухолевоспецифическую выживаемость достоверно влияли стадия pT (р = 0,01), степень дифференцировки по Фурману (р = 0,04), на общую выживаемость достоверно не оказывал влияния ни один из факторов. Таким образом, по данным регрессионного анализа Кокса наиболее значимым прогностическим фактором, влияющим на безрецидивную, общую и опухолевоспецифическую выживаемость в группе нсПКР, стала стадия pT (р <0,05).

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