Richstone Lee, Scherr Douglas S, Reuter Victor R, Snyder Mark E, Rabbani Farhang, Kattan Michael W, Russo Paul
Department of Urology, Memorial Sloan Kettering Cancer Center, New York, New York 10021, USA.
J Urol. 2004 Feb;171(2 Pt 1):615-20. doi: 10.1097/01.ju.0000106955.19813.f6.
We determined the frequency of tumor multifocality in patients with renal cortical tumors, characterized clinical and pathological features associated with multifocality and evaluated its effect on patient survival.
Between July 1989 and July 2002, 1,071 radical nephrectomies were performed at our institution. Specimens were examined grossly and microscopically for multifocal tumors. Preoperative imaging was reviewed to determine whether multifocality was suspected prior to operation. Multivariate analysis was performed to identify clinical and pathological factors associated with multifocality.
Of 1,071 radical nephrectomy specimens 57 (5.3%) had pathological evidence of tumor multifocality. Bilateral synchronous renal cortical tumors were present in 6 of the 57 multifocal cases (11%). A total of 19 cases (33%) had evidence of multifocality on preoperative imaging and, therefore, occult multifocality undetected on preoperative imaging was present in 3.5% of radical nephrectomies (38 of 1,071). Primary tumors in the multifocal group were most commonly conventional clear cell carcinoma, followed by papillary carcinoma. Of multifocal cases 74% had the same histological subtype in all tumors. Multivariate analysis demonstrated that bilaterality, papillary subtype, advanced tumor stage and lymph node metastasis were associated with multifocality. At a median follow up of 40.5 months overall survival, disease-free survival, and disease-free probability were not significantly different between the multifocal and unifocal groups.
We report a 5.3% frequency of multifocal renal cortical tumors and a 3.5% frequency of clinically unsuspected multifocal tumors. Multifocality had no apparent effect on recurrence or survival in patients who underwent radical nephrectomy.
我们确定了肾皮质肿瘤患者中肿瘤多灶性的发生率，描述了与多灶性相关的临床和病理特征，并评估了其对患者生存的影响。
1989年7月至2002年7月期间，我们机构共进行了1071例根治性肾切除术。对标本进行大体和显微镜检查以寻找多灶性肿瘤。回顾术前影像学检查以确定术前是否怀疑有多灶性。进行多变量分析以确定与多灶性相关的临床和病理因素。
在1071例根治性肾切除标本中，57例（5.3%）有肿瘤多灶性的病理证据。57例多灶性病例中有6例（11%）存在双侧同步肾皮质肿瘤。共有19例（33%）术前影像学检查有证据显示多灶性，因此，术前影像学检查未发现的隐匿性多灶性在3.5%的根治性肾切除术中存在（1071例中有38例）。多灶性组的原发肿瘤最常见的是传统透明细胞癌，其次是乳头状癌。在多灶性病例中，74%的所有肿瘤具有相同的组织学亚型。多变量分析表明，双侧性、乳头状亚型、肿瘤晚期和淋巴结转移与多灶性相关。中位随访40.5个月时，多灶性组和单灶性组的总生存、无病生存和无病概率无显著差异。
我们报告肾皮质肿瘤多灶性的发生率为5.3%，临床未怀疑的多灶性肿瘤发生率为3.5%。多灶性对接受根治性肾切除术患者的复发或生存无明显影响。
