Boorjian Stephen A, Crispen Paul L, Lohse Christine M, Leibovich Bradley C, Blute Michael L
Department of Urology, Mayo Medical School and Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Eur Urol. 2008 Oct;54(4):855-63. doi: 10.1016/j.eururo.2008.04.079. Epub 2008 May 9.
The origin of bilateral renal masses has not been definitively established to date. As limited studies on the genetics of bilateral tumors exist, defining the clinical behavior of these lesions remains important.
To evaluate the impact of synchronous versus metachronous presentation on clinicopathological outcomes of patients with bilateral renal masses.
DESIGN, SETTING, AND PARTICIPANTS: We identified 310 patients who were treated at the Mayo Clinic for sporadic bilateral renal masses between 1970-2003, including 148 (47.7%) with synchronous tumors and 162 (52.3%) with metachronous lesions.
Patients underwent surgical resection of bilateral renal tumors.
Clinicopathological features of synchronous and metachronous tumors were compared. Survival rates for patients with synchronous (n=92) and metachronous (n=100) renal cell carcinoma (RCC) were estimated using the Kaplan-Meier method and compared with the log rank test.
Metachronous tumors had a greater degree of pathological concordance than synchronous lesions, with 87.7% of metachronous tumors representing bilateral RCC, compared to 69.2% of synchronous masses (p=0.002). Patients with synchronous RCC tended to have an increased incidence of papillary RCC compared to patients with metachronous RCC, who were more likely to have bilateral clear-cell RCC (p=0.076). A longer interval between tumors was inversely associated with the risk of cancer death for patients with metachronous RCC (HR 0.90, 95% CI 0.81-0.99, p=0.039). Compared to patients with metachronous RCC, patients with synchronous bilateral RCC had similar 10-yr CSS (70.5% vs. 69.4%, p=0.51) and OS (47.5% vs. 51.2%, p=0.58). We nevertheless recognize that these findings may be limited by the study's retrospective, single-institution design.
Metachronous bilateral solid renal masses have a greater degree of pathological concordance and were more likely to represent malignancy. Surgical resection may provide durable cancer control for patients with bilateral RCC, with no difference in survival noted between synchronous and metachronous cancers.
双侧肾肿块的起源至今尚未明确确定。由于关于双侧肿瘤遗传学的研究有限，明确这些病变的临床行为仍然很重要。
评估同步性与异时性表现对双侧肾肿块患者临床病理结果的影响。
设计、地点和参与者：我们确定了1970年至2003年间在梅奥诊所接受散发性双侧肾肿块治疗的310例患者，其中148例（47.7%）为同步性肿瘤，162例（52.3%）为异时性病变。
患者接受双侧肾肿瘤手术切除。
比较同步性和异时性肿瘤的临床病理特征。使用Kaplan-Meier方法估计同步性（n=92）和异时性（n=100）肾细胞癌（RCC）患者的生存率，并与对数秩检验进行比较。
异时性肿瘤比同步性病变具有更高程度的病理一致性，87.7%的异时性肿瘤为双侧RCC，而同步性肿块为69.2%（p=0.002）。与异时性RCC患者相比，同步性RCC患者乳头状RCC的发病率往往更高，而异时性RCC患者更可能患有双侧透明细胞RCC（p=0.076）。肿瘤间隔时间越长，异时性RCC患者的癌症死亡风险越低（HR 0.90，95%CI 0.81-0.99，p=0.039）。与异时性RCC患者相比，同步性双侧RCC患者的10年癌症特异性生存率（CSS）相似（70.5%对69.4%，p=0.51），总生存率（OS）也相似（47.5%对51.2%，p=0.58）。然而，我们认识到这些发现可能受到该研究回顾性、单机构设计的限制。
异时性双侧实性肾肿块具有更高程度的病理一致性，更可能代表恶性肿瘤。手术切除可为双侧RCC患者提供持久的癌症控制，同步性和异时性癌症的生存率无差异。
