Department of Urology, Seoul National University College of Medicine, Seoul, Korea.
Urology. 2009 Dec;74(6):1271-5. doi: 10.1016/j.urology.2009.04.072. Epub 2009 Jul 17.
To evaluate the association between tumor diameter and clinicopathologic characteristics and metastatic potential in small (< or = 4 cm) renal cell carcinoma (RCC).
A total of 350 patients with an age range of 24-84 years (median, 54) were included in the study. Patients were categorized according to tumor diameter into 3 groups: < or = 2, 2.1-3.0, and 3.1-4.0 cm.
There were no significant differences in age, sex, histologic type, pathologic stage, and Fuhrman's grade according to tumor diameter. Tumor size did not predict synchronous metastatic disease. Distant metastases at diagnosis were documented in 2.1%, 1.6%, and 0.0% in patients with RCC of diameter < or = 2, 2.1-3, and 3.1-4 cm, respectively. During follow-up, recurrence or metastasis developed in 11 patients (3.5%) with a median time to metastasis of 43 months (range 7-104) in 345 patients with localized (N0M0) RCC. Metastases were diagnosed in 2 patients (0.9%) with RCC < or = 3 cm and in 9 patients (7.0%) with RCC 3.1-4.0 cm. Significant difference was noted in metastasis-free survival among groups (P = .023). Multivariate Cox proportional hazards model analysis showed that only tumor diameter was an independent predictor of metastasis-free survival (Hazard ratio, 5.344; 95% confidence interval, 1.137-25.127; P = .034).
Our findings suggest that risk of metachronous metastasis, but not synchronous metastasis, increases in RCC of diameter > 3.0 cm.
评估肿瘤直径与小（≤4cm）肾细胞癌（RCC）的临床病理特征和转移潜能之间的关系。
共纳入 350 例年龄 24-84 岁（中位年龄 54 岁）的患者。根据肿瘤直径将患者分为 3 组：≤2cm、2.1-3.0cm 和 3.1-4.0cm。
肿瘤直径与年龄、性别、组织学类型、病理分期和 Fuhrman 分级无关。肿瘤大小并不能预测同步转移疾病。在诊断时，直径≤2cm、2.1-3cm 和 3.1-4cm 的 RCC 患者中，分别有 2.1%、1.6%和 0.0%发生远处转移。在 345 例局部（N0M0）RCC 患者中，中位随访时间为 43 个月（范围 7-104），11 例（3.5%）患者复发或转移。在直径≤3cm 的 RCC 患者中，2 例（0.9%）和直径 3.1-4.0cm 的 RCC 患者中 9 例（7.0%）诊断出转移。组间无病生存率存在显著差异（P=0.023）。多因素 Cox 比例风险模型分析显示，只有肿瘤直径是无病生存率的独立预测因子（危险比，5.344；95%置信区间，1.137-25.127；P=0.034）。
我们的研究结果表明，直径>3.0cm 的 RCC 发生异时转移的风险增加，但同步转移的风险并未增加。
