【摘要翻译】散发肾细胞癌患者中低龄是独立的存活预后指标

[文题]YOUNG AGE IS AN INDEPENDENT PROGNOSTIC FACTOR FOR SURVIVAL OF SPORADIC RENAL CELL CARCINOMA.
散发肾细胞癌患者中低龄是独立的存活预后指标
[来源]Journal of Urology.
[年、卷、期、页]2004. 171(6, Part 1 of 2):2160-2165
[作者]SANCHEZ-ORTIZ, RICARDO F.; ROSSER, CHARLES J.; MADSEN, LYDIA T.; SWANSON, DAVID A.; WOOD, CHRISTOPHER G.
[原文摘要]
Purpose: Compared to older adults with renal cell carcinoma (RCC) our subjective impression has been that younger adults present with more unfavorable histological features and yet respond more favorably to aggressive therapies. We reviewed our experience to validate these observations.
Materials and Methods: We reviewed the medical records of 106 consecutive patients 40 years or younger and 145 consecutive 58 to 61-year-old patients referred for the surgical management of sporadic RCC between 1992 and 2002. Using univariate and multivariate analyses the pathological characteristics and outcome of the 2 groups were compared.
Results: Mean age of the young adults was 34.7 years (range 14 to 40). Of younger adults 24% had tumors with unfavorable features, such as sarcomatoid differentiation, unclassified histology, medullary carcinoma and collecting duct carcinoma, compared with 12% of older adults (p <0.02). However, older adults were more likely to have tumors of advanced local pathological stage (pT3a or greater) (46% vs 31%, p <0.04). Whereas young adults had a higher incidence rate of lymph node metastases at presentation (25% vs 15%, p <0.02), the rate of distant metastatic disease at presentation in young (34%) and older (28%) patients did not differ significantly (p = 0.33). Young age was independently associated with a higher 5-year actuarial disease specific survival rate on multivariate analysis at a median followup of 37 months (66% vs 52%, adjusted HR 2.64, 95% CI 1.45 to 4.79, p <0.002). On multivariate analysis of patients without distant metastases at presentation young adults also had improved recurrence-free survival (median time to recurrence 32.4 vs 23.5 months, HR 2.23, 95% CI 1.04 to 4.78, p <0.04).
Conclusions: Young adults with RCC were more likely to have unfavorable histological features and a higher incidence of lymph node metastases than an older cohort of adults. Despite these differences on multivariate analysis young patients had improved disease-specific and recurrence-free survival following treatment. Whether age specific differences in host-tumor interaction exist in patients with RCC deserves further study.
[中文译文]
目的：印象中，相对于高龄肾细胞癌患者，低龄患者的肿瘤组织学特征往往更差而对积极治疗反应更好。我们回顾了病历以验证这个观察得到的印象。
材料与方法：回顾1992-2000年间行手术治疗的106例年龄不超过40岁的肾细胞癌患者和145例58-61岁患者的病历，均为散发病例。应用单参数和多元分析2组的病理特征和治疗结果。
结果：低龄组平均年龄为34.7岁（14-40）。低龄组24%的患者肿瘤特性较差，例如类肉瘤样分化，未分类组织类型，髓样癌，集合管癌等，而高龄组只有12%患者如此（p<0.02）。而高龄组肿瘤局部分期往往是更晚期（pT3a或更晚）（46%，低龄组31%，p<0.04）。低龄组患者同时存在淋巴结转移的比率较大（25%，高龄组15%，p<0.02），两组发生远处转移的比率差别不显著（低龄组34%，高龄组28%，p=0.33）。平均随访37个月的情况下，应用多元分析发现低龄是独立的预后指标，提示更高的5年疾病特异生存率（66%，高龄组52%，adjusted HR* 2.64，95%CI 1.45-4.79，p<0.002）。多元分析还发现无远处转移的低龄患者有更长的无复发生存期（中位复发时间32.4月，高龄组23.5月，HR2.23，95% CI 1.04-4.78，p<0.04）。
结论：低龄肾细胞癌患者相对与高龄患者其肿瘤组织学特征更差，有更高的淋巴结转移发生率。尽管如此，多元分析发现，经过治疗，低龄患者有更长的疾病特异生存期和无复发生存期。肾细胞癌患者的宿主-肿瘤相互作用是否存在年龄差异有待进一步研究。

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[个人评论]一般印象中，应当老年人得的肿瘤，如果年轻人得了往往是组织学特征比较差，预后不好。而这篇文章说，虽然组织学特征差，可是积极治疗以后预后反而好。看来正如结尾所说，可能是宿主-肿瘤相互作用在起作用，年轻人毕竟免疫系统要好一些。
从这篇文章可见统计的魔力，确有点石成金的作用。相同的一组材料，用更合适的统计方法去做，得出的结论也更说明问题。可惜我的统计水平太差，有些术语都翻译不出来，还请高手指点。