• Te-Wei Chang, Wei-Ming Cheng, Yu-Hua Fan, Chih-Chieh Lin, Tzu-Ping Lin, Yi-Hsiu HuangEricEDepartment of Urology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC., Hsiao-Jen Chung, William J S Huang, and Shih-Han Weng.
• Division of Urology, Department of Surgery, Zhongxiao Branch, Taipei City Hospital, Taipei, Taiwan, ROC.
• J Chin Med Assoc. 2021 Apr 1; 84 (4): 405-409.

BackgroundFew prognostic factors have been proposed for patients with locally advanced renal cell carcinoma (RCC). This study aimed to investigate the possible predictive factors for disease-free survival (DFS) after curative surgery for RCC stage T3 or higher.MethodsPatients with locally advanced RCC who underwent cure-intended partial or radical nephrectomy, with or without tumor thrombectomy, at our institution from April 1, 2005 to October 31, 2013 were retrospectively reviewed. Those undergoing cytoreductive nephrectomy were excluded. Preoperative data, including surgical and pathologic characteristics, were assessed for correlation with DFS. Chi-square tests, univariate and multivariate Cox regression analysis, and Kaplan-Meier survival curve analyses were performed to determine potential predictive factors. A p value less than 0.05 was considered statistically significant.ResultsA total of 159 patients were included for analysis. The mean duration of follow-up was 37.9 months, and 119 (74.8%) patients remained disease-free during follow-up. Disease recurrence was found in 40 (25.2%) patients, and pathologic T stage, capsule penetration, Fuhrman grade, thrombocytosis, renal vein thrombosis, and elevated serum alkaline phosphatase, platelet/lymphocyte ratio, and γ-glutamyl transpeptidase levels were significantly associated with disease recurrence on univariate analysis. On multivariate analysis, Fuhrman grade 3 or 4 (HR = 5.70, p = 0.0003, 95% CI = 2.23-14.56) showed significant associations with DFS.ConclusionIn patients with locally advanced RCC, Fuhrman grade was associated with worse DFS after curative surgery. Urologists should closely monitor patients with high Fuhrman grades.Copyright © 2021, the Chinese Medical Association.

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