Schlomer Bruce, Figenshau Robert S, Yan Yan, Venkatesh Ramakrishna, Bhayani Sam B
Division of Urology, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
J Urol. 2006 Oct;176(4 Pt 1):1317-20; discussion 1320. doi: 10.1016/j.juro.2006.06.005.
We examined the relationship between tumor size and pathological findings in a contemporary series of surgical renal lesions and we characterized the relationship of incidental and symptomatic tumors to pathological findings.
We retrospectively reviewed the records of patients treated surgically for renal lesions suspicious for malignancy between March 2000 and May 2005. Specimens were examined for a gross and microscopic description. Statistical analysis was used to determine the correlation of size and symptomatology.
A total of 349 renal masses from 331 patients were identified. Of the 349 renal masses 56 (16.0%) were benign, 289 (82.8%) were renal cell carcinoma and 4 (1.1%) were other malignancies. The percent of malignant tumors increased from 72.1% for those less than 2 cm to 93.7% for those greater than 7 cm (OR 1.39, 95% CI 1.17 to 1.65). Of the 349 renal masses 258 (73.9%) were discovered incidentally and 91 (26.1%) were symptomatic. Mean size of incidental and symptomatic tumors was 3.7 and 6.2 cm, respectively (p < 0.001). When comparing T1 incidental and symptomatic tumors, there was no significant difference in the overall frequency of malignancy. When comparing T2 incidental and symptomatic tumors, the groups had similar malignancy rates (90.9% and 100%, respectively, p = 0.16). However, symptomatic lesions showed an increased incidence of high grade malignancy (78.4% vs 40.9%, p = 0.012).
Smaller renal tumors are more likely to be benign or be a lower grade of malignancy. T1 renal tumors are more likely to be detected incidentally than T2 tumors. When T1 incidental and symptomatic tumors were compared, there was no difference between the malignancy rates. However, when T2 incidental and symptomatic tumors were compared, symptomatic tumors were more likely to be high grade malignancy.
我们研究了当代一系列手术切除的肾病变中肿瘤大小与病理结果之间的关系，并对偶然发现的肿瘤和有症状的肿瘤与病理结果之间的关系进行了特征描述。
我们回顾性分析了2000年3月至2005年5月间因怀疑为恶性肾病变而接受手术治疗的患者记录。对标本进行大体和显微镜描述。采用统计分析来确定大小与症状之间的相关性。
共识别出331例患者的349个肾肿块。在这349个肾肿块中，56个（16.0%）为良性，289个（82.8%）为肾细胞癌，4个（1.1%）为其他恶性肿瘤。恶性肿瘤的比例从小于2 cm的患者中的72.1%增加到大于7 cm的患者中的93.7%（比值比1.39，95%可信区间1.17至1.65）。在这349个肾肿块中，258个（73.9%）是偶然发现的，91个（26.1%）有症状。偶然发现的肿瘤和有症状的肿瘤的平均大小分别为3.7 cm和6.2 cm（p < 0.001）。比较T1期偶然发现的肿瘤和有症状的肿瘤时，恶性肿瘤的总体发生率无显著差异。比较T2期偶然发现的肿瘤和有症状的肿瘤时，两组的恶性率相似（分别为90.9%和100%，p = 0.16）。然而，有症状的病变显示高级别恶性肿瘤的发生率增加（78.4%对40.9%，p = 0.012）。
较小的肾肿瘤更可能是良性的或恶性程度较低。T1期肾肿瘤比T2期肿瘤更有可能是偶然发现的。比较T1期偶然发现的肿瘤和有症状的肿瘤时，恶性率无差异。然而，比较T2期偶然发现的肿瘤和有症状的肿瘤时，有症状的肿瘤更有可能是高级别恶性肿瘤。
