[Anatomical classification of adenocarcinomas of the kidney. Reflections apropos of 270 surgically treated cases].
Prognostic correlation between the pathologic stage and survival was evaluated in 270 patients with renal cancer treated by enlarged nephrectomy and regional lymphadenectomy. Postoperative mortality varied in proportion to the extent of the tumor: 2.8% for intracapsular cancer, 6.4% for cancers invading perirenal fat, 9.4% for those extending into renal vein, 27.2% for those invading inferior vena cava, 17.4% for those with lymph node invasion and 17.6% for the metastatic tumors operated upon. Overall uncorrected survival was 63.5% at 5 years and 30.9% at 10 years, survival depending therefore on the developmental stage of the cancer. Intracapsular tumor: uncorrected survival at 5 years, 79.7% and at 10 years, 48.8%. For tumors invading perirenal fat without other dissemination: uncorrected survival at 5 years, 70.8% and at 10 years, 16.6%. Tumor extending into renal vein without caval or lymphatic invasion or metastases: uncorrected survival at 5 years, 56.2% and at 10 years, 30%, without any statistical difference from the 2 previous stages. Cancer with inferior vena cava invasion: 11 patients operated, 3 postoperative deaths, 4 metastatic recurrences between 11 and 40 months, and 4 survivors without metastases 6 to 55 months after operation. Cancer with lymphatic dissemination: no survivor in complete remission after 5 years. Cancer with bone or visceral metastases: uncorrected survival at 3 years, 8.3% (single peripheral metastasis irradiated). No operated patient with metastases survived for 5 years. A new classification is proposed: Stage I: intracapsular cancer more or less propagated into the renal vein. Stage II: cancer invading the perirenal fat with more or less propagation into renal vein. Stage III: propagation to the inferior vena cava excluding any lymphatic involvement.(ABSTRACT TRUNCATED AT 250 WORDS)
D000230:Adenocarcinoma / Q000145:classification / Q000473:pathology* / Q000556:secondary; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000145:classification / Q000401:mortality / Q000473:pathology*; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000401:mortality; D011379:Prognosis
La classification anatomique des adénocarcinomes du rein. Réflexions à propos de 270 cas traités chirurgicalement.