T1a 신세포암에서 근치적 신절제술 후 확인된 신주위 지방 침범: 예후인자로서의 중요성 및 영향을 미치는 병리학적 인자
Perirenal Fat Invasion(pT3a) in Renal Cell Carcinoma Less Than 4cm in Size(cT1a): Analysis of the Prognostic and Pathological Implications
한웅규, 변영준, 이용성, 김용수, 나군호, 홍성준, 양승철,
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한웅규 ( Han Woong-Kyu )
연세대학교 의과대학 비뇨기과학교실
변영준 ( Byun Young-Joon )
이화여자대학교 의과대학 비뇨기과학교실
이용성 ( Lee Yong-Seong )
연세대학교 의과대학 비뇨기과학교실
김용수 ( Kim Yong-Soo )
연세대학교 의과대학 비뇨기과학교실
나군호 ( Rha Koon-Ho )
연세대학교 의과대학 비뇨기과학교실
홍성준 ( Hong Sung-Joon )
연세대학교 의과대학 비뇨기과학교실
양승철 ( Yang Seung-Choul )
연세대학교 의과대학 비뇨기과학교실
KMID : 0358320060470060596
Abstract
Purpose: To investigate the incidence and histopathological factors of perirenal fat invasion(pT3a) in cT1a renal cell carcinomas. The implication for postoperative perirenal fat invasion, as a prognostic factor in patients with tumors less than 4cm tumor in size is also discussed.
Materials and Methods: Of 503 patients who underwent an operation for a renal cell carcinoma at our institution, between June 1995 and April 2004, we retrospectively reviewed the records of 176 with T1a renal cell carcinomas. We evaluated the pathological grade, cell type, tumor size, location and incidence of perirenal fat invasion using the Fisher’s exact test. The overall survival was estimated using the Kaplan-Meier method and log-rank test, and the prognostic factors influencing the survival were estimated using the Cox proportional hazard regression model.
Results: In this study, a radical nephrectomy was performed in 128 men and 48 women, with a mean age of 54.6 years, ranging from 23 to 77. The mean follow-up was 31.3 months, ranging from 6 to 106 months. The average size of the renal cell carcinomas was 3.0cm, ranging from 1 to 4cm. The incidence of perirenal fat invasion in the T1a renal cell carcinomas was 5.7%(n=10). The nuclear grade(p＜0.001) was a statistically significant factor in the incidence of postoperative perirenal fat invasion.
Conclusions: In the patients with a renal cell carcinoma less than 4cm in size(cT1a), those in the postoperative perirenal fat invasion group had a significantly poorer prognosis. The tumor size and Fuhrman nuclear grade were implicated in the incidence of perirenal fat invasion in the T1a renal cell carcinomas. Therefore, in the case of nephron sparing surgery, more precise preoperative staging of the primary tumor is required. (Korean J Urol 2006;47:596-600)
키워드
Renal cell carcinoma;Nephrectomy;Tumor staging
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