Date and place of thesis defense:
Prof. Sahib Muminagic
Clinical significance of prognostic factors for renal parenchymal carcinoma and a possibility of predicting the treatment outcome
Renal cell carcinoma makes 2-3% of all cancers in adults. Annually in the United States (U.S.) discovered around 30,000 new cases and about 11,900 die from the disease. In recent years there has been growth in the number of patients. Chances for cures primarily depend on disease stage and grade of secondary tumors. Only a radical surgical approach provides a good chance for recovery. Standard operation is radical nephrectomy, which involves complete removal Gerot;s fascia.
TNM classification is a fundamental principle for the determination of prognostic factors. Patients with stage I- have 5-year survival 90%, stage II about 83%, stage III about 64% and stage IV 25%.
Another important prognostic indicator is the nuclear grade. Increasing nuclear grade is inversely proportional to survival. For tumors grade I, 5-year survival was 86%, for tumors grade II was 79%, for tumors grade III was 59% and for tumors grade IV was 29%. In addition to the two most important prognostic parameter, mentions the involvement of the veins, the way of clinical presentation (incidental or symptomatic) and tumor size. Also proposed is a formula that includes the size of the tumor and the tumors clinical presentation of the way on the basis of which it is possible to determine the probability of five-year and ten-year survival.
The study included 158 patients with the carcinoma of renal parenchyma. We analyzed age and gender distribution, mode of detection, clinical stage, the size of the primary node, the general condition of the patient, nuclear grade and histopathological type of cancer.The average age of the patients was 57,5 ± 11,1 years. The disease was found in 90 male and 68 female subjects.
Survival was significantly different from the method of detection (p<0.0001). In patients in whom the disease is discovered incidentally, survival was 100% after 5 years. In patients with local or systemic symptoms five-year survival rate was 89.4% and 48,5%.
Survival was not significantly different from the general condition of the patients (p<0.0001). In patients who were ECOG 0 and 1, survival was 100% after 5 years. In patients who were ECOG 2 and 3, the five-year survival rate was 68,2% and 25 %.
Survival was not significantly different in relation to the clinical stage (p <0.0001). In patients who had stage I disease survival was 100% after 5 years. In patients who had a second and third stage, overall survival disease accounted for 89,7% and 69.2%, and in a fourth stage 0% after 2.6 years.
Primary node size does not correlate with survival (r=-0.154, p= 0.159). Dividing patients into subcategories relative to the size of the tumor node, are no significant difference in survival (logrank p=0.0775). Survival was not significantly different in relation to nuclear grade (NG) (p <0.0001). In patients who have had NG 1 survival was 100% after 5 years. In patients who have had NG 2 and 3 , year survival was 98.0% and 48,0 % , and 0% after 2.08 years in the patients with NG 4
Survival was not significantly different in relation to the histopathological type of cancer (p=0.0027) and was significantly longer for patients with a conventional type of cancer compared to chromophobe, 80,3% vs.61,5% at 5 years.
Overall survival of patients with carcinoma of the renal parenchyma was 81.2% after one year, 77.6% at 5 years and 70.4% after 10 years. Multivariate analysis showed that the clinical stage of the disease, the general condition of the patient and the nuclear grade are an independent predictors of disease outcome, where as tumor size node, the method of detection and histopathological type of illness does not meet the requirements for independent predictors.
Based on factors derived from multiple regression analysis determined a weight factor for independent predictors, and is calculated by the sum of the equation for each patient. The same was significantly higher in patients with fatal outcome, 0.809 ± 0.19 vs 0.034 ± 0.234 for patients who were alive (p<0.0001). The outcome accurately foreseen in 96.5% of patients, and 98.3% for a favorable outcome, and 92.0% for unfavorable outcome.
Key words :
renal cell carcinoma, survival , nomogram, prognostic factors