Sánchez-Ortiz Ricardo F, Madsen Lydia T, Bermejo Carlos E, Wen Sijin, Shen Yu, Swanson David A, Wood Christopher G
Department of Urology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
Cancer. 2004 Nov 15;101(10):2195-201. doi: 10.1002/cncr.20638.
Frequently, a renal mass is identified when patients with cancer undergo studies for staging or surveillance. In determining whether it represents a metastasis, patients are frequently subjected to percutaneous renal biopsies. The authors evaluated their experience with this dilemma to formulate management guidelines.
The authors reviewed the medical records of 100 consecutive patients with nonrenal malignancies diagnosed with renal masses at presentation or follow-up. Renal mass histology was available for all patients after nephrectomy or biopsy. Clinical characteristics were assessed to identify factors predictive for a renal metastasis versus a primary renal neoplasm.
The only factors predictive of a metastasis to the kidney were progression of the nonrenal malignancy and lack of enhancement of the renal mass (P < 0.0001). Forty-six patients (46%) had evidence of progression of their nonrenal malignancy in addition to the renal mass. In these patients, the probability of a metastasis to the kidney was 86% (95% confidence interval [CI], 57.2-98.2%) without renal mass enhancement and 32% (95% CI, 14-55%) with enhancing renal masses. None of the 54 patients without signs of progression of their nonrenal malignancy proved to have metastases to the kidney, regardless of the imaging characteristics of the mass (zero probability; 95% CI, 0-7%; P < 0.001).
In patients presenting with renal masses and another clinically localized malignancy, renal mass biopsies were not indicated, as the mass rarely represented a metastasis. These patients may opt for close surveillance or extirpation based on the prognosis of their nonrenal malignancy.
癌症患者在进行分期或监测检查时，经常会发现肾脏肿物。在确定该肿物是否为转移瘤时，患者常需接受经皮肾穿刺活检。作者评估了他们在处理这一难题时的经验，以制定管理指南。
作者回顾了100例连续的非肾恶性肿瘤患者的病历，这些患者在就诊或随访时被诊断出有肾脏肿物。所有患者在肾切除或活检后均有肾脏肿物的组织学检查结果。评估临床特征以确定预测肾转移瘤与原发性肾肿瘤的因素。
预测肾脏转移的唯一因素是非肾恶性肿瘤的进展和肾脏肿物无强化（P<0.0001）。46例患者（46%）除肾脏肿物外，还有非肾恶性肿瘤进展的证据。在这些患者中，肾脏肿物无强化时，肾转移的概率为86%（95%置信区间[CI]，57.2 - 98.2%）；肾脏肿物有强化时，肾转移的概率为32%（95%CI，14 - 55%）。54例无非肾恶性肿瘤进展迹象的患者中，无论肿物的影像学特征如何，均未证实有肾转移（概率为零；95%CI，0 - 7%；P<0.001）。
对于出现肾脏肿物且患有另一种临床局限性恶性肿瘤的患者，不建议进行肾肿物活检，因为该肿物很少为转移瘤。这些患者可根据其非肾恶性肿瘤的预后选择密切监测或切除。
