Jain Paresh, Surdas R, Aga Pallavi, Jain Manoj, Kapoor Rakesh, Srivastava Aneesh, Mandhani Anil
Department of Urology and Kidney Transplantation, SGPGIMS, Lucknow, India.
Indian J Urol. 2009 Oct-Dec;25(4):479-82. doi: 10.4103/0970-1591.57919.
Objective : Data correlating mode of presentation of renal cell carcinoma (RCC) with pathological prognostic factors is sparse from India. We compared RCC presenting incidentally with those presenting symptomatically with respect to pathological prognostic factors and assessed whether this could serve as a decision making resource for diagnosing small and more favorable tumors. Materials and Methods : The data were reviewed for 328 patients operated for renal tumors between January 2000 and October 2008 at our institute. The pathological factors (tumor size, stage, grade, histopathological type) in relation to the mode of presentation were analyzed according to 1997 TNM criteria. Statistical analysis was performed via the chi-square (Fisher exact) and Mann -Whitney U test. The statistical significance level utilized was P < 0.05. Results : Among the patients assessed, 93 (28.4%) had incidental diagnosis and 235 (71.6%) had symptomatic presentation. Sex and side distribution was not significantly different in the two groups. Mean tumor size was 5.75 +/- 2.73 cm in incidentally detected RCC (IRCC) and 9.32 +/- 3.70 (P < 0.001) in symptomatic RCC (SRCC). Stage I and II tumors were significantly greater in IRCC than SRCC (P < 0.001 and 0.005 respectively) whereas stage III and IV tumors were significantly less in IRCC than SRCC. There was a predominance of higher grade tumors in SRCC, 50% being higher grades (Fuhrman's grade III and IV) in SRCC than 28.1% in IRCC (P = 0.003). There were 4 tumors with collecting duct histology in SRCC and none in IRCC. Sarcomatoid differentiation was present in 14 and 1 patient in SRCC and IRCC respectively. Conclusion : Incidental detection of renal carcinoma as compared to symptomatic tumors is lower in India as compared to western world. Incidental tumors have significantly favorable pathological prognostic factors. Our results might form a basis for further studies on how to pick RCC at an earlier stage.
在印度，关于肾细胞癌（RCC）的临床表现模式与病理预后因素之间相关性的数据较为匮乏。我们比较了偶然发现的RCC与有症状表现的RCC在病理预后因素方面的情况，并评估这是否可作为诊断小的、预后较好肿瘤的决策依据。材料与方法：回顾了2000年1月至2008年10月在我院接受肾肿瘤手术的328例患者的数据。根据1997年TNM标准分析与临床表现模式相关的病理因素（肿瘤大小、分期、分级、组织病理学类型）。通过卡方检验（Fisher精确检验）和Mann-Whitney U检验进行统计分析。使用的统计学显著性水平为P<0.05。结果：在评估的患者中，93例（28.4%）为偶然诊断，235例（71.6%）为有症状表现。两组的性别和患侧分布无显著差异。偶然发现的RCC（IRCC）的平均肿瘤大小为5.75±2.73cm，有症状的RCC（SRCC）为9.32±3.70cm（P<0.001）。IRCC中I期和II期肿瘤显著多于SRCC（分别为P<0.001和0.005），而IRCC中III期和IV期肿瘤显著少于SRCC。SRCC中高级别肿瘤占优势，SRCC中50%为高级别（Fuhrman III级和IV级），而IRCC中为28.1%（P = 0.003）。SRCC中有4例为集合管组织学类型的肿瘤，IRCC中无。SRCC和IRCC中分别有14例和1例出现肉瘤样分化。结论：与西方世界相比，在印度，偶然发现的肾癌与有症状的肿瘤相比比例较低。偶然发现的肿瘤具有显著更好的病理预后因素。我们的结果可能为进一步研究如何在早期发现RCC奠定基础。
