[Study on the relationship between vascular invasion and prognosis in patients with locally confined renal cell carcinoma].
BACKGROUND
There exists controversy concerning the relationship between the vascular invasion and the prognosis in the locally confined renal cell carcinoma (RCC). We have tried to study on the relationship between the vascular invasion and the prognosis in these patients.


METHODS
Of the five hundred and forty-eight patients with RCC who did not have lymph node and distant metastasis, the 464 patients without having the micro- and/or macro-vascular invasion (tumour thrombus) were analysed as the control, and the remaining 85 with micro- and/or macro-vascular invasion were subject to this study.


RESULTS
There observed a significantly favourable prognosis in the patients with RCC who did not have the vascular invasion (pV0) compared with the patients who had the vascular invasion (pV1a: n = 43, P = 0.00068, pV1b: n = 34, 0 < P < 0.00006, pV2: n = 8, P = 0.012). Furthermore, the patients with pV1a showed a significantly favourable prognosis compared with the patients with pV1b (p = 0.00032), and the patients with pV2 (0 < P < 0.00006), and the patients with pV1b (P = 0.00032), and the patients with pV2 (0 < P < 0.00006), and the patients with pV1b also showed a significantly favourable prognosis compared with the patients with pV2 (0 < P < 0.0006). As to the relationship between the tumour size and vascular invasion (V-stage) the tumour size got larger along with the elevation of the V-stage, and there also observed a significant difference of the tumour size between the patients with pV10 and pV1a (P = 0.00578), with pV0 and pV1b (0 < P < 0.000061) and pV0 and pV2 (P = 0.0002). The same result was obtained in the relationship between the localization of the tumour and prognosis, i.e., the patients with pV2 showed a higher frequency of larger occupation of the tumour within the kidney compared with other V-stage patients. Regarding the recurrence rate, there observed a tendency toward high frequency of recurrence along with the elevation of V-stage. Furthermore, there observed an untoward relationship between the elevation of the V-stage and the periods of recurrence after nephrectomy. In an effort to analyse the disease-free survival, there observed a significant difference among the patients with pV0, pV1a, pV1b and pV2.


CONCLUSIONS
We conclude that the vascular invasion is a very important prognostic factor in the patients with locally confined RCC. Furthermore, along with the elevation of the V-stage, it directly reflects the poorer prognosis.
Department of Urology, Jikei University, School of Medicine.
T
T
Onishi
Y
Y
Ohishi
H
H
Goto
H
H
Suzuki
K
K
Asano
T
T
Hatano
M
M
Tomita
J
J
Madarame
H
H
Abe
D002292:Carcinoma, Renal Cell / Q000098:blood supply* / Q000473:pathology*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000098:blood supply* / Q000473:pathology*; D008297:Male; D009361:Neoplasm Invasiveness; D011379:Prognosis