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국소성 신세포암 환자에서 독립적인 예후인자로서 핵분화도의 의의

Significance of the Nuclear Grade as a Prognostic Factor for Patients with Localized Renal Cell Carcinoma

대한비뇨기과학회지 2007년 48권 5호 p.471 ~ 476
하지용 ( Ha Ji-Yong ) - 계명대학교 의과대학 비뇨기과학교실

장혁수 ( Chang Hyuk-Soo ) - 계명대학교 의과대학 비뇨기과학교실
김천일 ( Kim Chun-Il ) - 계명대학교 의과대학 비뇨기과학교실

Abstract


Purpose: As the number of patients with localized renal cell carcinoma has increased, there are conflicting reports on the nuclear grade as a prognostic factor. The aim of this study was to evaluate the significance of the nuclear grade as a prognostic factor.

Materials and Methods: We retrospectively enrolled 172 patients with localized renal cell carcinoma and who underwent radical nephrectomy. The patients were staged according to the 1997 TNM stage and the Fuhrman grading. The survival rate was analyzed by the Kaplan-Meier method. Multivariate analysis was performed using the Cox proportional hazard model.

Results: The overall 1- , 5- and 10-year survival rates were 98.1, 72.5 and 68.4%, respectively. The 5-year survival rates for grades I, II, III and IV were 100, 92.6, 85.0 and 60.9%, respectively(p<0.0001). According to the Fuhrman grade in each T stage, 1) for patients with pT1b, the 5-year survival rates were 100, 85.0, 85.71 and 33.3% for patients with grade I, II, III and IV, respectively(p=0.002). 2) for patients with pT2, the 5-year survival rates were 100, 92.3, 60.0 and 25.0% for patients with grade I, II, III and IV, respectively(p<0.0001). A comparison of the survival curves by the Fuhrman grade showed a statistically significant difference.

Conclusions: The Fuhrman grade is an important prognostic factor for patients with localized renal cell carcinoma. A high nuclear grade tends to have metastatic potential and a poor prognosis. This group of patients with a high nuclear grade must be followed up more closely. Determining the pathologic stage along with using the Fuhrman grade-based surveillance protocols are a logical approach to follow-up. (Korean J Urol 2007; 48:471-476)

키워드

Renal cell carcinoma;Survival rate;Cell nucleus shape
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