The clinical significance of microvascular invasion to the neogrowth in clinically nonmetastatic renal cell carcinoma / 中华泌尿外科杂志

ABSTRACT

Objective To study the significance of microvascular invasion to the neogrow in clinically nonmetastatic renal cell carcinoma (RCC). Methods Between 1989 and 1996,70 patients (mean age 54) were followed up for 1 to 7 years after radical nephrectomy for clinically localized RCC. Among them,there were 5 PT 1,50 PT 2,14 PT 3 and 1 PT 4 and histologically 7 G 1,38 G 2,19 G 3 and 6 G 4.The mean tumor diameter was 7.2 cm.The slides were stained with hematoxylin and eosin,elastin stains and periodic acid Schiff. then,the presence or absence of clinically inapparent vascular invasion,the relevance of microscopic vascular invasion to conventional tumor stage,grade and tumor diameter,et al were studied. Results Of the 70 patients analyzed,24(34.3%) had microvascular invasion,while 46 had none on microscopic examination.Of the microscopic vascular invasion group (11/24,45.8%),7 subsequently died of cancer recurrence,2 noncancer related death,4 alive with metastatic disease while only 4/46(8.7%) without microscopic vascular invasion presented with disease progression.Chi-square test showed statisticaly significant difference between stage,grade,tumor diameter and presence or absence of microscopic vascular invasion. A multivarite analysis was performed considering the impacts of age,PT stage,tumor grade,tumor diameter and microscopic vascular invasion on disease progression,an increase in statistical significance was confirmed with Coxs proportional hazards model(P=0.0062,RR=0.378). So, microscopic vascular invasion seems to be the most important predictor of progression in RCC. Conclusions In patients underwent radical nephrectomy for clinically nonmetastatic RCC,microvascular invasion may be another important prognostic marker and this makes us considering the presence of microscopic vascular invasion in RCC might be another pathological subcategory to predict the prognosis of RCC and can be used to choose whether early adjuvant therapy is necessary.