Patard J-J, Rodriguez A, Rioux-Leclercq N, Guillé F, Lobel B
Department of Urology and Pathology, CHU Rennes, France.
BJU Int. 2002 Sep;90(4):358-63. doi: 10.1046/j.1464-410x.2002.02910.x.
To evaluate the mode of detection of 400 renal tumours as a prognostic factor compared with the usual clinical and pathological prognostic variables.
The data were reviewed for 400 patients operated for a renal tumour at our institution between 1984 and 1999, analysing the prognostic value of age, sex, tumour size, stage, grade, vein invasion, adrenal gland invasion, lymph node invasion, metastasis, and mode of detection (incidental or not). The survival rates were assessed using the Kaplan-Meier method and log-rank test, and the data evaluated using multivariate analysis with the Cox proportional-hazard model.
In all, 151 (38%) renal tumours were discovered incidentally. There was no significant difference in the percentage of renal cell carcinoma found between the groups of patients discovered incidentally or not (94.4% vs 93.9%). Tumours were smaller in the incidental group (5.7 cm vs 8.7 cm, P < 0.001). In the incidental group, 15.2% of the tumours were treated with partial nephrectomy, against 1.2% in the symptomatic group (P < 0.001). The specific survival was significantly better in patients with renal tumours discovered incidentally (log-rank test, P < 0.001). The multivariate analysis showed that the mode of detection, stage, grade, metastasis (all P < 0.001), and lymphatic extension (P = 0.005) were independent prognostic factors.
The incidental discovery of renal tumours gives a supplementary benefit to patients in terms of survival, and should be considered as a prognostic factor in addition to stage and grade.
与常用的临床和病理预后变量相比，评估400例肾肿瘤的检测方式作为一种预后因素。
回顾了1984年至1999年间在我院接受肾肿瘤手术的400例患者的数据，分析年龄、性别、肿瘤大小、分期、分级、静脉侵犯、肾上腺侵犯、淋巴结侵犯、转移及检测方式（偶然发现与否）的预后价值。采用Kaplan-Meier法和对数秩检验评估生存率，并使用Cox比例风险模型进行多变量分析来评估数据。
总共偶然发现了151例（38%）肾肿瘤。偶然发现和未偶然发现的患者组中肾细胞癌的发现百分比无显著差异（94.4%对93.9%）。偶然发现组的肿瘤较小（5.7 cm对8.7 cm，P<0.001）。在偶然发现组中，15.2%的肿瘤接受了部分肾切除术，而有症状组为1.2%（P<0.001）。偶然发现肾肿瘤的患者的特异性生存率显著更好（对数秩检验，P<0.001）。多变量分析表明，检测方式、分期、分级、转移（均P<0.001）和淋巴管浸润（P = 0.005）是独立的预后因素。
肾肿瘤的偶然发现对患者的生存有额外益处，除分期和分级外，应将其视为一种预后因素。
