Satellite Nodule의 존재여부가 근치적 신절제술을 시행한 환자의 생존율에 미치는 영향
The Effect of Presence of Satellite Nodules in Nephrectomized Kidney on Survival in Patients with Renal Cell Carcinoma
소속 상세정보
이상은/Sang Eun Lee
김대영/손환철/조규선/변석수/박문수/김현회/Dae Young Kim/Hwancheol Son/Kyu Sun Cho/Seok Soo Byun/Moon Soo Park/Hyeon Hoe Kim
KMID : 0358319980390121201
Abstract
결론
1987년 1월부터 1991년 6월까지 서울대학교병원에서 신세포암으로 근치적 신절제술에 의해
제거된 81개의 신장중 15개에서 satellite nodule이 발견되었으며, satellite nodule의 발현빈
도와 수는 원발종양의 병기가 증가함에 따라 유의하게 증가하였고 원발종양의 크기와
satellite nodule의 발현빈도사이에도 유의한 상관관계를 나타내었다. 그러나 원발종양의 크
기와 satellite nodule의 수 사이에는 통계학적으로 유의한 상관관계를 보이지 않았다 또한
satellite nodule의 유무에 따른 5년 생존율은 각각 50.0%와 89.7%로 양군간에 의미있는 차
이를 보이지 않는 것으로 보아 satellite nodule이 종양의 신장내 전이보다는 종양의 다발성
에 인한 것을 시사한다고 할 수 있다. 그러나 satellite nodule이 종양의 크기와 병기에 비례
해 발견되었고, 또 원발종양과 satellite nodule의 병리조직학적 소견이 같았다는 점은 종양
의 다발성보다는 신장내의 전이에 가까운 소견이라 추정할 수 있다. 이를 종합해 보면 아직
까지 satellite nodule의 임상적 의의는 정확히 알 수 없지만 크기가 작은 저병기의 신세포암
에서 신보존수술이 더욱 보편화되기 위해서는 향후 satellite nodule에 대한 전향적 임상연구
와 분자생물학적 연구가 뒤따라야 할 것으로 생각된다
#초록#
Purpose : There are still some debates concerning kidney preserving surgery for
ipsilateral renal cell carcinoma and normal contralateral kidney. It has been proposed that
about 10 to 20 per cent of the renal cell carcinoma have satellite nodules along with the
main tumor mass. But the exact prognostic implication of the satellite nodules has not
been clarified yet. In this study, we tried to evaluate whether the presence of the
satellite nodules would be an adverse prognostic factor or not after radical nephrectomy.
Materials and Methods : From January 1987 until June 1991, 81 patierlts underwent
radical nephrectomy, and all of the nephrectomized kidneys were serially cut into slices
of 5 mm to probe for any satellite nodules. All the satellite nodults found were
examined histologically. All the patients were followed regularly for the mean duration
of 67 months.
Results : The patholologic stage of the primary tumor was T1 in 19 patients, T2 in 38,
T3 in 22 and T4 in 2 patients. Overall 5 year survival rate was 89.5%. Fifteen
patients(18.5%) had satellite nodules with histologically identical patterns to the primary
tumor, The presence of the satellite nodules increased according to the increasing tumor
stage and the size of the primary tumor mass. The survival rate was significantly
decreased with the increasing tumor stage, with the 5 year survival rate of 100% in T1,
96.6% in T2, 71.3% in T3 and none in T4 patients(p=0.0001). But the 5 year survival
rate of patients with primary tumor with a diameter of less than 7cm was 96.4%
compared to 81.7% who have primary tumor with a diameter 7cm and more(p=0.16).
Additionally the presence of the satellite nodules did not have an impact on the survival.
The 5 year survival rate was 89.7% in patients without satellite nodules and it was 90%
in patients with satellite nodules(p=0.87).
Conclusions : There was significant correlation between pathological stage of the prima
tumor and survival rate. However, the presence of the satellite nodule and the primary
tumor size did not appear to have an impact on survival. We suggest that the molecular
biological study for satellite nodule is needed to characterize the satellite nodule in
addition to histopathological study.
키워드
Renal cell carcinoma; Satellite nodule; Prognostic factor;
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