Department of Urology, Mayo Clinic, Rochester, MN, USA.
BJU Int. 2012 Jan;109(2):190-4; discussion 194. doi: 10.1111/j.1464-410X.2011.10184.x. Epub 2011 May 9.
To determine the metastatic potential of renal masses based on original tumour size.
We identified 2651 patients who had undergone surgical resection for a unilateral, sporadic renal tumour between 1990 and 2006. Associations of tumour size with synchronous metastasis at presentation [M1 renal cell carcinoma (RCC)] and development of metastases, death from RCC, and death from any cause after surgery were evaluated using logistic and Cox proportional hazards regression.
Of the 2651 patients studied, 182 (6.9%) presented with M1 RCC. Tumour size was significantly greater in patients with M1 RCC than in patients with M0 RCC (a median size of 10 vs 4.5 cm; P < 0.001). Only 1 of the 629 patients (0.2%) with a tumour <3 cm had M1 RCC and that tumour was 2.5 cm. The risk of M1 RCC increased from 1.1% for patients with tumours 3-3.9 cm to 16.5% for patients with tumours ≥7 cm. Of the 2124 patients with M0 RCC, 430 developed distant metastases at a median (range) of 1.4 (0.1-16.2) years after surgery. Only 9 of the 498 patients (1.8%) with a tumour <3 cm developed distant metastases after surgery. Each 1-cm increase in tumour size increased the risk of death from RCC by 20%[hazard ratio (HR) 1.20; 95% confidence interval (CI) 1.18-1.22; P < 0.001] and death from any cause by 10% (HR 1.10; 95% CI 1.09-1.12; P < 0.001). For the 1346 patients who were still alive at last follow-up, the median (range) duration of follow-up was 6.9 (0.1-19.7) years.
Tumour size is significantly associated with metastases in patients with renal masses. Patients with tumours <3 cm have a low risk of synchronous metastatic disease.
根据原始肿瘤大小确定肾脏肿块的转移潜能。
我们确定了 1990 年至 2006 年间接受单侧、散发性肾肿瘤手术切除的 2651 名患者。使用逻辑和 Cox 比例风险回归评估肿瘤大小与同期转移（M1 肾细胞癌[RCC]）和转移发展、RCC 死亡以及手术后任何原因死亡的相关性。
在研究的 2651 名患者中，182 名（6.9%）患者表现为 M1 RCC。M1 RCC 患者的肿瘤大小明显大于 M0 RCC 患者（中位数大小分别为 10cm 和 4.5cm；P <0.001）。在 629 名肿瘤<3cm 的患者中，仅有 1 名患者发生 M1 RCC，肿瘤大小为 2.5cm。肿瘤为 3-3.9cm 的患者 M1 RCC 风险从 1.1%增加到肿瘤≥7cm 的患者的 16.5%。在 2124 名 M0 RCC 患者中，430 名患者在手术后中位数（范围）1.4 年（0.1-16.2 年）时发生远处转移。仅有 498 名肿瘤<3cm 的患者中，有 9 名患者在手术后发生远处转移。肿瘤大小每增加 1cm，RCC 死亡风险增加 20%[风险比（HR）1.20；95%置信区间（CI）1.18-1.22；P <0.001]，任何原因死亡风险增加 10%（HR 1.10；95%CI 1.09-1.12；P <0.001）。在最后一次随访时仍存活的 1346 名患者中，中位（范围）随访时间为 6.9 年（0.1-19.7 年）。
肿瘤大小与肾肿瘤患者的转移显著相关。肿瘤<3cm 的患者发生同步转移性疾病的风险较低。
