Onishi T, Ohishi Y, Goto H, Suzuki M, Miyazawa Y
Department of Urology, Jikei University School of Medicine, Tokyo, Japan.
BJU Int. 1999 Jun;83(9):937-43. doi: 10.1046/j.1464-410x.1999.00094.x.
To determine the clinicopathological characteristics of histologically defined papillary renal cell carcinoma (RCC) in relation to prognosis.
In total, 768 patients with RCC underwent nephrectomy at our university hospital between 1957 and 1995. RCC was classified into clear-cell carcinoma in 689 patients (89.7%, no follow-up in 14), chromophobe cell carcinoma in 36 (4.7%, no follow-up in two) and papillary RCC in 43 (5.6%, no follow-up in one). In the present study, the 42 patients with papillary RCC who underwent nephrectomy and were followed up were those in whom the clinicopathological features of the papillary RCC were assessed. Factors assessed were the presence or absence of foam-cell infiltration, occurrence of bleeding and/or necrosis, presence or absence of a pseudocapsule, mixed occurrence with clear-cell carcinoma, presence or absence of solid variants, cytoplasmic appearance (basophilic vs eosinophilic cells), stage, nuclear grade of malignancy, and angiographic appearance in relation to prognosis. The prognosis was also compared among patients with clear-cell, chromophobe cell and papillary RCC.
The prognosis was significantly better in patients with foam-cell infiltration (P=0.03), with a pseudocapsule (P=0.07), with no solid variants (P=0.001) and with basophilic cells (P<0.001). There were also significant differences in survival between patients with low-stage (1+2) and high-stage (3+4) disease (P=0.003), and among grades 1-3 (grade 1 vs 2, P=0.05; grade 1 vs 3, P<0.001, grade 2 vs 3, P=0.006). Furthermore, the prognosis in patients with papillary RCC was worse than in those with chromophobe cell carcinoma (P=0.02), but there was no significant difference in survival between patients with papillary RCC and those with clear-cell carcinoma.
The clinicopathological features (e.g. the presence or absence of foam cells, of a pseudocapsule and of solid variants, cytoplasmic appearance, and the stage and nuclear grade of malignancy) are important prognostic factors for patients with papillary RCC. Furthermore, the prognosis in patients with papillary RCC is similar to those with clear-cell carcinoma.
确定组织学定义的乳头状肾细胞癌（RCC）的临床病理特征及其与预后的关系。
1957年至1995年间，共有768例RCC患者在我校医院接受了肾切除术。RCC分类如下：透明细胞癌689例（89.7%，14例未随访），嫌色细胞癌36例（4.7%，2例未随访），乳头状RCC 43例（5.6%，1例未随访）。在本研究中，对42例行肾切除术并接受随访的乳头状RCC患者评估了其临床病理特征。评估的因素包括是否存在泡沫细胞浸润、出血和/或坏死的发生情况、是否存在假包膜、与透明细胞癌的混合发生情况、是否存在实体变体、细胞质外观（嗜碱性细胞与嗜酸性细胞）、分期、核恶性分级以及与预后相关的血管造影表现。还比较了透明细胞、嫌色细胞和乳头状RCC患者的预后。
有泡沫细胞浸润的患者（P=0.03）、有假包膜的患者（P=0.07）、无实体变体的患者（P=0.001）和有嗜碱性细胞的患者（P<0.001）预后明显较好。低分期（1+2期）和高分期（3+4期）患者的生存率也有显著差异（P=0.003），1-3级患者之间也有显著差异（1级与2级，P=0.05；1级与3级，P<0.001，2级与3级，P=0.006）。此外，乳头状RCC患者的预后比嫌色细胞癌患者差（P=0.02），但乳头状RCC患者与透明细胞癌患者的生存率无显著差异。
临床病理特征（如是否存在泡沫细胞、假包膜和实体变体、细胞质外观以及分期和核恶性分级）是乳头状RCC患者重要的预后因素。此外，乳头状RCC患者的预后与透明细胞癌患者相似。
