Institute of Urologic Oncology, UCLA Department of Urology, Los Angeles, CA 90095-1738, USA.
BJU Int. 2011 Aug;108(3):343-8. doi: 10.1111/j.1464-410X.2010.09871.x. Epub 2010 Nov 19.
• To evaluate whether current nephrectomy pathology reports are sufficient to allow clinicians to use prognostic nomograms, tailor surveillance, enroll patients into adjuvant trials and select systemic therapy for renal cell carcinoma (RCC).
• Nephrectomy pathology reports were obtained from the LA County Tumor Registry. Key reporting elements identified by the College of American Pathology (CAP) and utilized in RCC prognostic models were abstracted. Hospital type was coded as community, teaching or cancer centre. • Reporting quality was assessed across hospital type and year.
• A total of 317 of 344 sampled reports (92.2%) met the inclusion criteria. Tumour size and margin status were commonly reported. Some 90.2% and 84.2% of reports provided data on histology and Fuhrman grade. Tumour classification was omitted in 27.8%. • Microvascular invasion and necrosis were infrequently reported (44.5% and 25.6%, respectively). Only 59.9% of reports met CAP guidelines for tumour classification, margin, size, histology and grade. • Two prognostic nomograms (Stage, Size, Grade and Necrosis system and Kattan) could rarely be utilized (15.8% and 12.3%, respectively), whereas the UCLA Integrated Staging System could be used frequently (65.6%). There were discrepancies satisfying CAP guidelines between community, teaching and cancer centre hospitals, with 54.7%, 70.5% and 75% of reports meeting CAP criteria (P= 0.0102).
• Current RCC pathology reporting fails to satisfy CAP guidelines, does not permit the use of prognostic systems, and may hinder enrollment into adjuvant trials and the selection of systemic therapy. Important reporting discrepancies exist between hospital types, with cancer centres performing best. • Quality improvement initiatives to encourage consistent, comprehensive and clinically relevant pathology reports would improve the quality of RCC patient care.
评估目前的肾切除术病理报告是否足以让临床医生使用预后列线图，调整监测方案，招募患者参加辅助试验，并选择肾细胞癌（RCC）的系统治疗。
从洛杉矶县肿瘤登记处获取肾切除术病理报告。从美国病理学院（CAP）确定并用于 RCC 预后模型的关键报告要素被提取出来。医院类型被编码为社区医院、教学医院或癌症中心。报告质量在医院类型和年份上进行评估。
共有 317 份抽样报告（92.2%）符合纳入标准。肿瘤大小和边缘状态通常有报告。约 90.2%和 84.2%的报告提供了组织学和 Fuhrman 分级的数据。肿瘤分类被遗漏了 27.8%。微血管侵犯和坏死很少有报告（分别为 44.5%和 25.6%）。只有 59.9%的报告符合 CAP 肿瘤分类、边缘、大小、组织学和分级指南。两个预后列线图（分期、大小、分级和坏死系统以及 Kattan 系统）很少能被利用（分别为 15.8%和 12.3%），而 UCLA 综合分期系统则可以经常使用（65.6%）。社区、教学和癌症中心医院之间存在符合 CAP 指南的差异，分别有 54.7%、70.5%和 75%的报告符合 CAP 标准（P=0.0102）。
目前的 RCC 病理报告不符合 CAP 指南，不能使用预后系统，可能会阻碍辅助试验的入组和系统治疗的选择。不同医院类型之间存在重要的报告差异，癌症中心表现最好。为了鼓励一致、全面和具有临床相关性的病理报告，需要进行质量改进倡议，以提高 RCC 患者的护理质量。
