tumeurs, dont le carcinome à cellule rénales, à la progres-
sion tumorale et l’apparition de métastases [19].
Dans notre étude l’expression de la molécule d’adhésion
CD44 est plus forte chez les patients ayant un mauvais
pronostique et sa sur expression est associée à une mor-
talité accrue. Cependant l’effectif est trop faible pour étu-
dier la valeur pronostique indépendante de ce marqueur
comme cela a été montré par P
A R A D I S
[14] et par notre
groupe dans la population générale des RCC [18].
CONCLUSION
Cette étude a permis de mettre en évidence certains fac-
teurs pronostiques péjoratifs du cancer du rein des sujets
de moins de 40 ans. Ceux ci ne semblent pas fonda-
mentalement différents des critères connus chez le sujet
plus âgé. Ce sont : le stade et le grade tumoral, l’enva-
hissement veineux et la surexpression de la molécule
CD44. Néanmoins l’effectif faible en raison de la rareté
de ces tumeurs rend nécessaire la réalisation d’études
multicentriques qui permettront de tester le caractère
indépendant de ces variables pour prédire la survie.
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____________________
SUMMARY
Prognostic factors of renal cell carcinoma before the age of 40.
O b j e c t i v e: To study the prognostic value of tumour diameter, TNM
stage, Führman’s nuclear grade and CD44 adhesion molecule
e x p r ession in renal cell carcinoma (RCC) before the age of 40 years.
Material and Methods: Nineteen patients under the age of 40
(12 males and 7 females; mean age 30.8 years), undergoing
total nephrectomy for RCC were included in this study. Tumour
diameter, TNM 1997 stage, and Führman’s nuclear grade were
defined for each tumour. Standard CD44 adhesion molecule
(CD44H) expression was evaluated semiquantitatively by immu -
nohistochemistry on each tumour. The prognostic value of the
various variables was determined by Mann-Whitney and Chi-
square tests and survival analysis was performed by the Kaplan-
Meier method.
Results: Six patients (31.5%) died from their cancer with a
mean follow-up of 81.4 months. Mean tumour diameter was 9 ±
4.5 cm. Tumours were Führman I/II in 4 cases, Führman III/IV
in 15 cases, T1/T2 in 14 cases and T3/T4 in 5 cases. CD44H
expression was high (≥ 20%) in 9 cases (47.3%). The prognos -
tic factors identified in this study were: tumour stage (p=0.01),
grade (p=0.04), venous extension (p=0.001) and CD44H ove -
rexpression (p=0.003).
Conclusion: Prognostic factors of renal cancer in patients under
the age of 40 years do not appear to be different from those of
older patients. The prognostic factors identified in this study must
be validated by multicentre studies based on larger populations.
Key-words: carcinoma, renal cell; prognosis; survival, age.
578
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S. Moudouni et coll;., Progrès en Urologie (2002), 12, 575-578