Skolarus Ted A, Serrano Maria F, Berger David A, Bullock Travis L, Yan Yan, Humphrey Peter A, Kibel Adam S
Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine and Barnes Jewish Hospital, St. Louis, Missouri, USA.
J Urol. 2008 Feb;179(2):439-43; discussion 443-4. doi: 10.1016/j.juro.2007.09.076.
The 2004 World Health Organization histological classification of renal tumors reflects our understanding of the underlying molecular determinants of renal tumors. We reviewed all partial and radical nephrectomy specimens at Barnes-Jewish Hospital to determine if the distribution of renal tumor histological subtypes varies by decade of life using the new scheme.
A total of 1,043 consecutive cases of renal masses operated on for presumed malignancy from 1989 to 2003 were identified. All specimens were rereviewed by a single pathologist (MFS) and classified by the 2004 WHO scheme. In addition to decade of life and histological subtype, gender, tumor size and pathological tumor stage were analyzed.
Analysis demonstrated an association between histological subtype and decade of life (p <0.001). The proportions of clear cell renal cell carcinoma (p = 0.008) and angiomyolipoma (p <0.001) decreased while the proportions of oncocytoma (p <0.001) and papillary renal cell carcinoma (p = 0.005) increased with increasing decade of life. The proportions of chromophobe (p = 0.181) and unclassified (p = 0.660) renal cell carcinoma did not change with increasing decade of life. In addition, younger patients were more likely to have larger tumors (p = 0.019) and metastatic disease at diagnosis (p = 0.017), while gender (p = 0.809) and tumor stage (p = 0.334) were not associated with increasing decade of life.
This study provides baseline histological subtypes by decade for the most common renal tumors using the 2004 WHO histological classification. Clinicians may consider using these trends along with imaging, history and physical examination to counsel patients before recommending treatment.
2004年世界卫生组织肾肿瘤组织学分类反映了我们对肾肿瘤潜在分子决定因素的理解。我们回顾了巴恩斯犹太医院的所有部分肾切除术和根治性肾切除术标本，以确定使用新方案时肾肿瘤组织学亚型的分布是否随年龄的十年而变化。
确定了1989年至2003年期间共1043例因疑似恶性肿瘤而接受手术的肾肿块连续病例。所有标本均由一名病理学家（MFS）重新审查，并根据2004年世界卫生组织方案进行分类。除了年龄的十年和组织学亚型外，还分析了性别、肿瘤大小和病理肿瘤分期。
分析表明组织学亚型与年龄的十年之间存在关联（p<0.001）。随着年龄的十年增加，透明细胞肾细胞癌（p = 0.008）和平滑肌瘤（p<0.001）的比例下降，而嗜酸细胞瘤（p<0.001）和乳头状肾细胞癌（p = 0.005）的比例增加。嫌色性（p = 0.181）和未分类（p = 0.660）肾细胞癌的比例没有随着年龄的十年增加而变化。此外，年轻患者在诊断时更有可能患有更大的肿瘤（p = 0.019）和转移性疾病（p = 0.017），而性别（p = 0.809）和肿瘤分期（p = 0.334）与年龄的十年增加无关。
本研究使用2004年世界卫生组织组织学分类提供了最常见肾肿瘤按年龄十年划分的基线组织学亚型。临床医生在推荐治疗前为患者提供咨询时，可考虑结合这些趋势以及影像学、病史和体格检查。
