Langzeitprognose des Nierenzellkarzinoms in Abhängigkeit von Staging, Grading und Art der Therapie

Marc Holzgraefe, Kälble, Tilman (Prof. Dr. Med.), Operative Medizin
2011
The renal cell carcinoma shows with a median 5-year-overall-survival of 71% and a 10 year-OS of 58% a good prognosis. There is no significant higher survivaltime for male compared to femal patients, since the risc of RCC is 1.5 times higher to male patients. In this cohort age of diagnosis was 59.6 years for males und 62.3 yrs for femals. There was no significant difference found in the side or location in the kidney. A bilateral RCC was found in 3.5% of the cases. Most of RCC were found by
more » ... ce, classic trias of upper abdominal pain, tumor and macrohaematuria was seldom (6.3%). Of 427 patients 397 were treated by tumornephrectomie, 33 by enucleation. The controlperiod lasted for 50 month. Both staging systems of the UICC (1987 and 1997)and the update of 2002 had a certain prognostic relevance. The 5 and 10 yrs OS-times of the newest pT-stagings were: pT1 79% (72%), pT2 67% (57%), pT3 60 (41%) sowie pT4 0% (0%). The UICC 5-system was more precise in seperating these stages according OS and rezidivfree OS. The cut off-point of 4 cm to seperate pT1a from pT1b selected in 2002 was sensible due to treatment of these little tumors by enucleation. Lymphnode- and metastasis-status were positiv predictors of survival. The Fuhrmann-grading predicts very pecise OS an RFOS for high- and low grade tumors but was not sensitiv in separation of G1 and G2 tumors. Enucleation of kidney tumors is a match to tumornephrectomie in small tumors. The is no significant statistical difference in OS and RFOS. Intraoperative complications in enucleation are seldom, mortality is low. There is no loss in radicality of treatment, but to compare enucleation versus nephrectomie in small tumors the cohorts should be bigger. More investigation is needed
doi:10.17192/z2005.0477 fatcat:46biyg2x25dbbmz52c2xuac7bm