[Prognostic factors for disease progression in patients with renal cell carcinoma].
BACKGROUND
More than 40% of patients with renal cell carcinoma present with disease progression after surgery. The objective of the current study was to identify a clinically useful set of prognostic factors that would correlate significantly with the capacity of progression.


METHODS
The authors studied 252 patients with renal cell carcinoma who underwent radical nephrectomy. Followup ranged from 12-246 months (median 36 months). Several morphologic parameters of the tumors were considered. DNA content was analyzed by flow cytometry and tumor size was determined from the surgical specimen. A Cox proportional hazards regression model was used to identify significant independent prognostic factors for disease progression.


RESULTS
A total of 224 out of 252 were available for suitable histograms. Of the 224 patients, 95 (42.4%) were aneuploid tumors, 106 (47.2%) were organ-confined renal cell carcinoma and 87 (39.74%) presented disease progression. At 5 and 10 years of followup, disease free survival was found to be 66.31% and 62.23%, respectively. Univariate analysis revealed that DNA ploidy, Furhman grade and stage (TNM) had a statistically significant predictive value for disease progression. Survival univariate analysis found a worse probability of survival for aneuploid tumors, grade III-IV tumors, non organ-confined tumors and conventional and undiferentiated tumors. Using multivariate survival analyses, Furhman grade, stage (TNM) and DNA ploidy were the only independent prognostic factors. So, the probability of death for aneuploid tumor was 1.7 times higher than for diploid tumors.


CONCLUSIONS
Stage, DNA content and Furhman grade were the only significant independent predictors of disease progression. Tumoral size and histological type did not provide more additional information.
Budía Alba
A
A
Servicio de Urología, Hospital Universitario la Fe de Valencia. budia@pulso.com
Gómez Pérez
L
L
Bango
V
V
Ruiz-Cerdá
J I
JI
Sempere
A
A
Queipo
J A
JA
Jiménez Cruz
J F
JF
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D018450:Disease Progression; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D011379:Prognosis; D016019:Survival Analysis