Patel Manish I, Simmons Rachel, Kattan Michael W, Motzer Robert J, Reuter Victor E, Russo Paul
Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
Urology. 2003 May;61(5):921-5. doi: 10.1016/s0090-4295(02)02578-5.
To assess the clinical characteristics, pathology, and long-term follow-up of patients with bilateral nonfamilial renal tumors (BNFRTs).
Patients with BNFRTs and unilateral tumors were identified from a prospective surgery database. The Mann-Whitney U test, Cox proportional hazards regression analysis, and the log-rank test were used to compare groups.
From a database of 1082 patients with nonmetastatic renal tumors, 46 were identified with BNFRTs (4.25%). Thirty-three had synchronous tumors and 13 had asynchronous tumors. The median patient age of BNFRT patients was 61 years. Of the 92 renal tumors in these 46 patients, 42% were managed with radical nephrectomy (RN) and 58% with partial nephrectomy (PN); 7 underwent bilateral PN. The tumors were conventional clear cell carcinoma in 66% (n = 61), papillary carcinoma in 14% (n = 13), and the remaining 20% were of varied histologic origin. A 76.2% concordance was noted between the histologic subtypes of the two renal tumors in each patient. Median follow-up was 74 months. Thirty-three patients (72%) were disease-free and 7 patients had recurrence (2 local, 5 metastatic). Compared with patients having unilateral disease, BNFRT patients had an equivalent disease-free survival (DFS) (bilateral: 3-year DFS 90%, 5-year DFS 83%; unilateral: 3-year DFS 92%, 5-year DFS 82% [P = 0.449]). No difference in DFS was observed between synchronous and asynchronous tumors.
BNFRTs were present in 4.25% of patients with sporadic renal tumors. Conventional clear cell histology was the most common histologic subtype; concordance among tumors was found to be 76%. DFS rates comparable to those of unilateral tumors can be obtained by using combinations of PN and RN.
评估双侧非家族性肾肿瘤（BNFRTs）患者的临床特征、病理学及长期随访情况。
从一个前瞻性手术数据库中识别出BNFRTs患者和单侧肿瘤患者。采用Mann-Whitney U检验、Cox比例风险回归分析和对数秩检验对各组进行比较。
在1082例非转移性肾肿瘤患者的数据库中，有46例被识别为BNFRTs（4.25%）。33例为同步肿瘤，13例为异时性肿瘤。BNFRTs患者的中位年龄为61岁。在这46例患者的92个肾肿瘤中，42%接受了根治性肾切除术（RN），58%接受了部分肾切除术（PN）；7例接受了双侧PN。肿瘤类型为传统透明细胞癌的占66%（n = 61），乳头状癌占14%（n = 13），其余20%组织学来源各异。每位患者的两个肾肿瘤组织学亚型之间的一致性为76.2%。中位随访时间为74个月。33例患者（72%）无疾病复发，7例患者复发（2例局部复发，5例转移复发）。与单侧疾病患者相比，BNFRTs患者的无病生存期（DFS）相当（双侧：3年DFS为90%，5年DFS为83%；单侧：3年DFS为92%，5年DFS为82% [P = 0.449]）。同步肿瘤和异时性肿瘤之间的DFS无差异。
散发性肾肿瘤患者中4.25%存在BNFRTs。传统透明细胞组织学是最常见的组织学亚型；肿瘤之间的一致性为76%。通过联合使用PN和RN可获得与单侧肿瘤相当的DFS率。
