Lee Cheryl T, Katz Jared, Fearn Paul A, Russo Paul
Department of Urology, University of Michigan Hospitals, 1500 E. Medical Center Drive, Box 0330, Ann Arbor, MI 48109, USA.
Urol Oncol. 2002 Jul-Aug;7(4):135-40. doi: 10.1016/s1078-1439(01)00185-5.
Broadened applications of imaging modalities have increased the incidental detection of renal cell carcinoma (RCC) over the past decade. Previous small series have suggested a prognostic benefit for incidental presentation. This study utilizes a large contemporary patient cohort to examine patterns of RCC presentation and their clinical implications.
Retrospective analysis was performed on 721 patients (260 women, 461 men) who underwent 750 nephrectomies for treatment of RCC between 7/1/89 and 12/31/97; 29 patients required two operations for bilateral RCC. Median age and follow-up were 63 years and 41 months, respectively. Indicators of symptomatic presentation included flank pain, flank mass, hematuria, varicocele, constitutional symptoms, paraneoplastic syndromes, and bone pain related to metastatic disease. Mode of presentation was compared with clinicopathologic parameters using Chi-square and t-test analyses. Survival analysis was performed using Kaplan-Meier estimates (log-rank test) and Cox regression modeling.
Incidental and symptomatic presentation occurred in 57% and 42% of cases, respectively. When compared to incidental cases, symptomatic presentation was predominantly detected in younger patients (mean age, 59 years; P < .001), in males (P < .04), and in tumors with conventional (clear cell) histology (P < .001), larger size (mean, 8 cm; P < .001), and non-organ confined pathology (P < .001). In univariate analysis, symptomatic cases had a more adverse disease-free (P < .0001) and disease-specific (P < .0001) survival. In multivariate analysis, mode of presentation was an independent predictor of disease-free (P < 0.0001) and disease-specific survival (P < 0.005).
Symptomatic presentation correlates with an aggressive histology and advanced disease. Incidental tumors may be frequently detected in female and elderly patients, as these groups traditionally seek general medical care more regularly. Mode of presentation can independently predict an adverse patient outcome and should be included in RCC-specific modeling systems.
在过去十年中，成像模态应用范围的扩大增加了肾细胞癌（RCC）的偶然发现率。此前的小样本研究表明偶然发现的RCC具有预后优势。本研究利用一个大型当代患者队列来研究RCC的发现模式及其临床意义。
对1989年7月1日至1997年12月31日期间因治疗RCC而接受750例肾切除术的721例患者（260例女性，461例男性）进行回顾性分析；29例双侧RCC患者需接受两次手术。中位年龄和随访时间分别为63岁和41个月。症状性表现的指标包括胁腹痛、胁腹肿块、血尿、精索静脉曲张、全身症状、副肿瘤综合征以及与转移性疾病相关的骨痛。使用卡方检验和t检验分析将发现模式与临床病理参数进行比较。使用Kaplan-Meier估计法（对数秩检验）和Cox回归模型进行生存分析。
偶然发现和有症状表现的病例分别占57%和42%。与偶然发现的病例相比，有症状表现的病例主要在较年轻患者（平均年龄59岁；P < .001）、男性（P < .04）以及具有传统（透明细胞）组织学（P < .001）、较大尺寸（平均8 cm；P < .001）和非器官局限性病理（P < .001）的肿瘤中被发现。在单因素分析中，有症状表现的病例无病生存期（P < .0001）和疾病特异性生存期（P < .0001）更差。在多因素分析中，发现模式是无病生存期（P < 0.0001）和疾病特异性生存期（P < 0.005）的独立预测因素。
有症状表现与侵袭性组织学和晚期疾病相关。偶然发现的肿瘤可能在女性和老年患者中更频繁地被发现，因为这些群体传统上更经常寻求普通医疗护理。发现模式可独立预测不良的患者预后，应纳入RCC特异性建模系统。
