Murphy Alana M, Buck Adam M, Benson Mitchell C, McKiernan James M
Department of Urology, Columbia University, Medical Center, New York, New York 10032, USA.
Urology. 2009 Jun;73(6):1293-7. doi: 10.1016/j.urology.2008.12.072. Epub 2009 Apr 15.
To determine whether the detection of benign renal tumors is increasing and to identity the predictors of benign histologic features. The detection of renal cortical tumors has increased with the increased use of abdominal imaging. Current imaging and biopsy techniques cannot predict the renal tumor histologic features with complete accuracy, and many patients undergo surgery for benign lesions.
The Columbia Urologic Oncology Database was reviewed, and 1244 patients who had undergone partial or radical nephrectomy from 1988 to 2007 were identified. A cohort of 775 patients with a tumor diameter of <or.0 cm, nonmetastatic disease, and nonfamilial disease was selected. Univariate and multivariate logarithmic regression analyses were used to determine the parameters to predict for benign histologic features.
The proportion of renal surgery for benign tumors of <or.0 cm in diameter has increased annually. When patients were stratified by the year of surgery, the proportion of benign tumors was 5.0% before 1998, 15.2% from 1998 to 2003, and 21.2% from 2004 to 2007. The mean diameter of benign and malignant tumors was 3.0 and 3.5 cm, respectively, and the mean tumor diameter significantly decreased during the study period (P = .006). Using multivariate analysis, the year of surgery, tumor diameter, and female sex were independent predictors of benign histologic features (P < .05). Age, incidental diagnosis, body mass index, and race were not significant predictors (P > .05).
Even when controlling for tumor diameter and sex, the incidence of benign tumors detected at renal surgery at our institution has increased significantly in the past 2 decades.
确定良性肾肿瘤的检出率是否在上升，并找出良性组织学特征的预测因素。随着腹部影像学检查的使用增加，肾皮质肿瘤的检出率也有所上升。目前的影像学和活检技术无法完全准确地预测肾肿瘤的组织学特征，许多患者因良性病变接受了手术。
回顾了哥伦比亚大学泌尿外科肿瘤数据库，确定了1988年至2007年期间接受部分或根治性肾切除术的1244例患者。选择了775例肿瘤直径小于或等于4.0 cm、无转移疾病且无家族性疾病的患者。采用单因素和多因素对数回归分析来确定预测良性组织学特征的参数。
直径小于或等于4.0 cm的良性肿瘤的肾手术比例逐年增加。按手术年份对患者进行分层时，1998年以前良性肿瘤的比例为5.0%，1998年至2003年为15.2%，2004年至2007年为21.2%。良性和恶性肿瘤的平均直径分别为3.0 cm和3.5 cm，在研究期间平均肿瘤直径显著减小（P = 0.006）。采用多因素分析，手术年份、肿瘤直径和女性性别是良性组织学特征的独立预测因素（P < 0.05）。年龄、偶然诊断、体重指数和种族不是显著的预测因素（P > 0.05）。
即使在控制肿瘤直径和性别后，在过去20年里，我们机构肾手术中检测到的良性肿瘤的发生率仍显著增加。
