Predictive characteristics for disease recurrence and overall survival in non-metastatic clinical T1 renal cell carcinoma – results from the National Swedish Kidney Cancer Register

Patients with clinical T1 renal cell carcinoma (cT1RCC) have risks for recurrence and reduced overall survival despite being in the best prognostic group. This study aimed to evaluate the association of different treatments on disease recurrence and overall survival using clinical and pathological characteristics in a nation-wide cT1RCC cohort. A total of 4,965 patients, registered in the National Swedish Kidney Cancer Register (NSKCR) between 2005 and 2014, with ≥ 5-years follow-up were identified: 3,040 males and 1,925 females, mean age 65 years. Times to recurrence and overall survival were analyzed with Kaplan-Meier curves, log-rank test, and Cox regression models. Age, TNM-stage, tumor size, RCC-type, and performed treatment were all associated with disease recurrence. Patients selected for ablative treatments had increased risk for recurrent disease: hazard ratio (HR) = 3.79 [95% confidence interval (CI) = 2.69–5.32]. In multivariate analyses, age, gender, tumor size, RCC-type, N-stage, recurrence and performed treatment were all independently associated with overall survival. Patients with chRCC had a 41% better overall survival (HR = 0.59, 95% CI = 0.44–0.78; <i>p</i> &lt; 0.001) than ccRCC. Patients treated with partial nephrectomy (PN) had an 18% better overall survival (HR = 0.83, 95% CI = 0.71–0.95, <i>p</i> &lt; 0.001) than patients treated with radical nephrectomy. Age, gender, T-stage, tumor size, RCC type and treatment modality are all associated with risk of recurrence. Furthermore, age, male gender, tumor size, N-stage and recurrence are associated with reduced overall survival. Patients with chRCC, compared with ccRCC and pRCC patients, and PN compared with RN treated patients, had an advantageous overall survival, indicating a possible survival advantage of nephron sparing treatment.

临床T1期肾细胞癌（clinical T1 renal cell carcinoma, cT1RCC）患者虽归属预后最佳组别，但仍存在疾病复发风险，且总体生存率有所下降。本研究旨在基于临床与病理特征，在全国性cT1RCC队列中评估不同治疗方案与疾病复发及总体生存率的关联。本研究共纳入2005年至2014年间登记于瑞典全国肾癌登记库（National Swedish Kidney Cancer Register, NSKCR）且随访时长≥5年的4965例患者，其中男性3040例、女性1925例，平均年龄65岁。研究采用Kaplan-Meier曲线、log-rank检验及Cox回归模型对复发时间与总体生存率进行分析。年龄、TNM分期、肿瘤大小、肾细胞癌亚型及所采用的治疗方案均与疾病复发相关。接受消融治疗的患者疾病复发风险升高：风险比（hazard ratio, HR）=3.79，95%置信区间（confidence interval, CI）为2.69~5.32。多因素分析结果显示，年龄、性别、肿瘤大小、肾细胞癌亚型、N分期、复发情况及所采用的治疗方案均与总体生存率独立相关。与透明细胞肾细胞癌（clear cell renal cell carcinoma, ccRCC）患者相比，嫌色细胞肾细胞癌（chromophobe renal cell carcinoma, chRCC）患者的总体生存率高出41%（HR=0.59，95%CI=0.44~0.78；P<0.001）。与接受根治性肾切除术（radical nephrectomy, RN）的患者相比，接受肾部分切除术（partial nephrectomy, PN）的患者总体生存率高出18%（HR=0.83，95%CI=0.71~0.95，P<0.001）。年龄、性别、T分期、肿瘤大小、肾细胞癌亚型及治疗方式均与疾病复发风险相关。此外，年龄、男性性别、肿瘤大小、N分期及复发情况均与总体生存率降低相关。与透明细胞肾细胞癌（ccRCC）和乳头状肾细胞癌（papillary renal cell carcinoma, pRCC）患者相比，嫌色细胞肾细胞癌（chRCC）患者，以及与接受根治性肾切除术（RN）的患者相比，接受肾部分切除术（PN）的患者均具有更优的总体生存率，这提示肾单位保留治疗可能存在生存获益。