Siow W Y, Yip S K, Ng L G, Tan P H, Cheng W S, Foo K T
Department of Urology, Singapore General Hospital, Singapore.
J R Coll Surg Edinb. 2000 Oct;45(5):291-5.
In developed countries, there has been increased incidental detection of renal cell carcinoma (RCC). The incidence, pathological stage and survival of incidentally detected carcinoma in a developing country in Asia where, from 1990 to 1998, 165 renal cell carcinomas were identified. The clinical presentation, diagnostic-imaging modality employed, pathological staging and patient survival was reviewed. Incidental renal cancers included those that were diagnosed through health screening or detected incidentally through imaging studies for other conditions. The survival between these incidentally detected lesions and their symptomatic counterparts (suspected group) was compared. Sixty-four patients (39%) had their tumours detected incidentally, including 39 who were entirely asymptomatic and 25 who presented with non-specific symptoms, not initially suggestive of RCC. For the entire group, computed tomography provided the definitive diagnosis in 81% of cases. The incidental detection group had significantly smaller size of tumour (5.9 cm c.f. 7.6 cm), lower stage and lower histological grading. In particular, 78% of patients with incidental RCC had stage I or II diseases (TNM stage classification), compared with 57% of patients with suspected tumour (p < 0.05; Chi-square test). The disease free survival was significantly better for those with incidental detection (86% c.f. 66% at last follow up; p < 0.05; log-rank test) over a mean follow up period of 33 months (range 1-91). Regression analysis showed that stage of disease was the only independent variable predictive of clinical outcome. In conclusion, that significant numbers of RCC were detected incidentally. These tumours were of a lower clinical pathological stage and had a better prognosis.
在发达国家，肾细胞癌（RCC）的偶然检出率有所增加。在亚洲的一个发展中国家，1990年至1998年期间共确诊了165例肾细胞癌，对其发病率、病理分期及生存情况进行了研究。回顾了这些病例的临床表现、所采用的诊断成像方式、病理分期及患者生存情况。偶然发现的肾癌包括通过健康筛查诊断出的以及因其他病症进行影像学检查时偶然发现的。比较了这些偶然发现的病灶与其有症状的对应病灶（疑似组）的生存率。64例患者（39%）的肿瘤是偶然发现的，其中39例完全无症状，25例有非特异性症状，最初未提示为肾细胞癌。对于整个研究组，计算机断层扫描在81%的病例中提供了明确诊断。偶然发现组的肿瘤明显较小（5.9厘米对比7.6厘米），分期较低，组织学分级也较低。特别是，偶然发现肾细胞癌的患者中78%为I期或II期疾病（TNM分期分类），而疑似肿瘤患者中这一比例为57%（p<0.05；卡方检验）。在平均33个月（范围1 - 91个月）的随访期内，偶然发现组的无病生存率明显更好（最后一次随访时为86%对比66%；p<0.05；对数秩检验）。回归分析表明疾病分期是预测临床结果的唯一独立变量。总之，大量肾细胞癌是偶然发现的。这些肿瘤的临床病理分期较低，预后较好。
