Combes François, Saidi Abdelkader, Delaporte Véronique, Lechevallier Eric, André Marc, Daniel Laurent, Coulange Christian
Service d'Urologie, Hôpital Salvator, Marseille, France.
Prog Urol. 2005 Dec;15(6):1062-9.
The purpose of this study was to demonstrate the prognostic value of subdivision of tubulopapillary tumours into 2 histological subtypes and to discuss the therapeutic implications.
This was a single-centre retrospective study of 58 cases from a series of 414 patients operated for renal cancer between 1988 and 2001 based on review of histology slides (biopsies and operative specimens). The radiological assessment was based on ultrasound reports and review of CT scans. Karyotypes were described by cytogenetic analysis.
Tubulopapillary tumours represented 14% of all kidney tumours with a male prevalence of 77% and a mean age of 56.5 years. The overall mean follow-up was 62.6 months. Treatment consisted of 25 right radical nephrectomies, 29 left radical nephrectomies and 4 partial nephrectomies. 84% of tumours were low-grade and 80% were low stage T1 or T2. Multifocal lesions were observed in 31% of cases. Synchronous bilateral lesions were observed in 12% of cases. The 5-year survival was 95% and the 10-year survival was 87%, correlated with stage, grade, tumour diameter, presence of necrosis and low enhancement. According to the data reported by Delahunt, 2 subtypes can be distinguished: Type I tumours (75%) with low grade and low stage were correlated with a high rate of multifocal lesions (30%) with a genetic predisposition. Type 2 tumours (25%), usually unifocal, were correlated with a higher grade and stage, confirmed by their poorer prognosis. Biopsy allows a distinction of the type and grade of the tumour.
In our series, for equivalent mean tumour diameters (55 mm), tubulopapillary tumours treated by radical nephrectomy had a good prognosis regardless of their subtype. Classification of the tumour by biopsy prior to surgery could have implications for therapeutic management. For type 1 tubulopapillary tumours identified on preoperative biopsy, we propose radical nephrectomy due to the high risk of multifocal lesions (30%). Although partial nephrectomy may be indicated for type 1 tubulopapillary tumours less than 4 cm, the patient must be informed about the risk of recurrence and the importance of long-term follow-up. Studies including a larger number of patients must be conducted to compare the survival associated with type 2 tumours compared to that of the classical histological subtype.
本研究旨在阐明将肾小管乳头状肿瘤细分为两种组织学亚型的预后价值，并探讨其治疗意义。
这是一项单中心回顾性研究，对1988年至2001年间因肾癌接受手术的414例患者中的58例进行了研究，基于组织学切片（活检和手术标本）的回顾。放射学评估基于超声报告和CT扫描回顾。通过细胞遗传学分析描述核型。
肾小管乳头状肿瘤占所有肾肿瘤的14%，男性患病率为77%，平均年龄为56.5岁。总体平均随访时间为62.6个月。治疗包括25例右肾根治性切除术、29例左肾根治性切除术和4例部分肾切除术。84%的肿瘤为低级别，80%为低分期T1或T2。31%的病例观察到多灶性病变。12%的病例观察到同步双侧病变。5年生存率为95%，10年生存率为87%，与分期、分级、肿瘤直径、坏死的存在和低强化相关。根据Delahunt报告的数据，可区分出两种亚型：I型肿瘤（75%），低级别和低分期，与多灶性病变的高发生率（30%）及遗传易感性相关。II型肿瘤（25%），通常为单灶性，与更高的分级和分期相关，其预后较差证实了这一点。活检可区分肿瘤的类型和分级。
在我们的系列研究中，对于平均肿瘤直径相当（55毫米）的情况，根治性肾切除术治疗的肾小管乳头状肿瘤无论其亚型如何预后都较好。术前通过活检对肿瘤进行分类可能对治疗管理有影响。对于术前活检确定为I型肾小管乳头状肿瘤，由于多灶性病变的高风险（30%），我们建议行根治性肾切除术。虽然对于小于4厘米的I型肾小管乳头状肿瘤可能适合行部分肾切除术，但必须告知患者复发风险及长期随访的重要性。必须开展纳入更多患者的研究，以比较II型肿瘤与经典组织学亚型的生存率。
