국소 신세암에서 종양의 크기에 의한 T1 병기의 재분류

Abstract

Recently, new cutoffs have been proposed to restage T1 stage of renal cell carcinoma, because prognostic differences become more prominent by these cutoffs. Using new cutoffs (2.5cm, 3cm, 4cm, 5cm, 7cm, 10cm, capsule invasion), we evaluated the validity of these cutoffs by restaging the patients with localized renal cell carcinoma (T1-2, N0, M0) We studied retrogradely 99 patients with pathologically confirmed T1 and T2 carcinomas who had undergone radical nephrectomy from June 1990 to March 2002. The sugjects comprised of 61 men and 38 women with mean age of 56.2 years (range 21-78 years). The mean follow up length was 69 months (range 8-162months). The subjects were divided into two groups using new cutoff points, and the survival curves were calculated by Kaplan-Meier method at each cutoff points and Log-rank tests were used to compare the value of new cutoff points. Statistically significant cancer specific survivals were observed at 4cm, and 7cm cutoffs, and a 5cm cutoff point showed maximal the differences in cancer specific survivals. A 4cm cutoff point was the only statistically significant cutoff value of disease free survivals. Capsule invasion was not statistically significant cutoff value. We, therefore, propose a 5cm cutoff point to divide T1N0M0 classification into T1a and T1b subclasses. Patients with localized renal cell carcinoma larger than 4cm size should be considered for radical nephrectomy rather than partial nephrectomy, become of concern about local recurrence.