Gudbjartsson Tomas, Thoroddsen Asgeir, Petursdottir Vigdis, Hardarson Sverrir, Magnusson Jonas, Einarsson Gudmundur V
Department of Urology, Landspitali National University Hospital, Reykjavik, Iceland.
Urology. 2005 Dec;66(6):1186-91. doi: 10.1016/j.urology.2005.07.009.
To conduct a population-based study to evaluate the effect of incidental detection of renal cell carcinoma (RCC) on survival. Incidental detection of RCC has increased significantly in recent years because of widespread use of abdominal imaging. The patients with incidentally diagnosed RCC have better survival; however, because of possible "lead time" bias and stage migration, the real implications of incidental detection on survival have been a matter of debate.
All living patients diagnosed with RCC in Iceland between 1971 and 2000 were included (n = 701). The histologic findings were verified, the stage (extent) of the disease was determined, and the incidence, mortality, and survival were evaluated.
The strongest predictors of mortality were stage and nuclear grade. After correcting for these factors in the multivariate analysis, incidental diagnosis, histologic subtype, and gender lost their significance as independent prognostic factors of death. However, the incidentally diagnosed tumors were 2.3 cm smaller on average and at a lower stage and grade than symptomatic tumors, with significantly better patient survival than those with symptomatic tumors on univariate analysis (76% versus 44% 5-year disease-specific survival). An increased incidence of RCC was only seen in men, but incidental detection increased threefold during the study period in both sexes, with significant improvement in survival for the whole group as a result.
The increased frequency of incidental detection has improved the survival of patients with RCC in Iceland. Incidental detection was not an independent prognostic factor of death, indicating that these tumors are of a similar biologic nature as symptomatic RCCs, only diagnosed earlier.
开展一项基于人群的研究，以评估肾细胞癌（RCC）偶然发现对生存的影响。由于腹部影像学的广泛应用，近年来RCC的偶然发现显著增加。偶然诊断出的RCC患者生存率更高；然而，由于可能存在“领先时间”偏倚和分期迁移，偶然发现对生存的实际影响一直存在争议。
纳入1971年至2000年间冰岛所有诊断为RCC的在世患者（n = 701）。核实组织学检查结果，确定疾病分期（范围），并评估发病率、死亡率和生存率。
死亡率的最强预测因素是分期和核分级。在多变量分析中校正这些因素后，偶然诊断、组织学亚型和性别作为死亡的独立预后因素失去了意义。然而，偶然诊断出的肿瘤平均比有症状的肿瘤小2.3 cm，分期和分级更低，单变量分析显示其患者生存率明显高于有症状的肿瘤患者（5年疾病特异性生存率分别为76%和44%）。RCC发病率仅在男性中增加，但在研究期间，两性的偶然发现均增加了三倍，结果全组生存率显著提高。
偶然发现频率的增加提高了冰岛RCC患者的生存率。偶然发现不是死亡的独立预后因素，表明这些肿瘤与有症状的RCC具有相似的生物学性质，只是诊断得更早。
