Department of Urology, Tokyo University Hospital, Tokyo, Japan.
J Urol. 2010 Jul;184(1):64-8. doi: 10.1016/j.juro.2010.03.019. Epub 2010 May 15.
It was previously thought that renal cell carcinoma with a diameter of 3 cm or less has low potential to cause distant metastasis. However, metastasis develops in a small number of cases, which cannot be ignored. We investigated the clinicopathological characters of small renal cell carcinoma with metastasis to further understand this condition.
From January 1983 to February 2009, 165 cases of sporadic renal cell carcinoma 3 cm or less were treated at our department. Bilateral and von Hippel-Lindau disease were excluded from study. Clinicopathological parameters and outcome data were collected on each patient and analyzed.
Histologically the 165 cases of primary renal cell carcinoma 3 cm or less included 151 of clear cell, 10 of papillary and 4 of chromophobe renal cell carcinoma, of which 4 had sarcomatoid differentiation, 6 had perinephric and/or sinus invasion and 20 had microvascular invasion. Overall we identified 10 metastatic cases (6.06%), of which 5 were synchronous. Univariate analysis revealed that age 60 years or greater (p = 0.0139), symptoms (p = 0.0054) and microvascular invasion (p <0.0001) were significant risk factors. Multivariate analysis showed that only microvascular invasion was a significant risk factor (p = 0.00062). Perinephric and/or sinus fat invasion was not a significant risk factor.
Metastasis also develops in small renal cell carcinoma cases. Results suggest that microvascular invasion is a significant risk factor and patients with microvascular invasion should be followed more carefully.
此前人们认为直径 3cm 或以下的肾细胞癌转移到远处的可能性较低。然而，在少数情况下仍会发生转移，这一点不容忽视。我们研究了发生转移的小体积肾细胞癌的临床病理特征，以进一步了解这种情况。
1983 年 1 月至 2009 年 2 月，我们科室共治疗了 165 例直径 3cm 或以下的散发性肾细胞癌患者，排除了双侧和 von Hippel-Lindau 病患者。收集每位患者的临床病理参数和预后数据，并进行分析。
组织学上，这 165 例 3cm 或以下的原发性肾细胞癌包括 151 例透明细胞癌、10 例乳头状癌和 4 例嫌色细胞癌，其中 4 例有肉瘤样分化，6 例有肾周和/或肾窦侵犯，20 例有微血管侵犯。我们共发现 10 例转移病例（6.06%），其中 5 例为同步转移。单因素分析显示，年龄 60 岁或以上（p=0.0139）、有症状（p=0.0054）和微血管侵犯（p<0.0001）是显著的危险因素。多因素分析显示，只有微血管侵犯是显著的危险因素（p=0.00062）。肾周和/或肾窦脂肪侵犯不是显著的危险因素。
小体积肾细胞癌也会发生转移。结果表明，微血管侵犯是一个显著的危险因素，有微血管侵犯的患者应更加密切地随访。
