Department of Pathology, Urology Service, Memorial Sloan-Kettering Cancer Center New York, NY 10065, USA.
Am J Surg Pathol. 2011 Jul;35(7):962-70. doi: 10.1097/PAS.0b013e31821a455d.
Despite multiple studies, many clinicopathologic issues about chromophobe renal cell carcinoma (RCC) remain contentious; for example, its biological behavior-whether better or similar to papillary RCC, the incidence of sarcomatoid features, and whether pathologic features such as necrosis, nuclear grade, and tumor stage predict worse outcome. We studied 203 consecutive primary chromophobe RCCs resected at our institution in an attempt to answer these and other questions. The tumors showed significant progressive decrease in size and stage (P=0.047 and 0.001) from 1980 to 2000. Five patients had metastasis at presentation, and further disease-specific events (recurrence/metastasis/death due to disease) occurred in 8 more. Only 4 of 203 tumors had sarcomatoid features. Over median follow-up of 6.1 years (range, 0.1 to 18 y), 5-year and 10-year disease-specific events occurred in 3.7% (95% CI, 1.5%, 7.4%) and 6.4% (95% CI, 2.7%, 12.2%) patients. Outcomes showed significant association with tumor size, small-vessel invasion, sarcomatoid features, and microscopic necrosis (P≤0.05 each). pT stage or nodal metastasis tended to show some association, without reaching statistical significance (P=0.05 and 0.06, respectively). A modified tumor grading scheme, somewhat similar to that proposed recently, mitotic index, cytologic eosinophilia, and architecture, were not significantly associated with outcome. In conclusion, sarcomatoid differentiation is quite uncommon in chromophobe RCC. Tumor size, small-vessel invasion, sarcomatoid differentiation, and microscopic necrosis are the only features that are significantly associated with adverse outcome. On the basis of this long follow-up on a large number of cases, chromophobes seem to have better clinical outcomes than those reported for clear cell and papillary RCCs.
尽管进行了多项研究，但关于嗜铬细胞瘤肾细胞癌（RCC）的许多临床病理问题仍然存在争议；例如，其生物学行为——是否优于或类似于乳头状 RCC、肉瘤样特征的发生率，以及坏死、核分级和肿瘤分期等病理特征是否预示着更差的预后。我们研究了在我们机构连续切除的 203 例原发性嗜铬细胞瘤，试图回答这些和其他问题。从 1980 年到 2000 年，肿瘤的大小和分期显著逐渐缩小（P=0.047 和 0.001）。5 例患者在就诊时发生转移，另外 8 例发生进一步的疾病特异性事件（复发/转移/死于疾病）。203 例肿瘤中仅有 4 例具有肉瘤样特征。在中位随访 6.1 年（范围 0.1 至 18 年）期间，5 年和 10 年的疾病特异性事件发生率分别为 3.7%（95%CI，1.5%，7.4%）和 6.4%（95%CI，2.7%，12.2%）。结果与肿瘤大小、小血管浸润、肉瘤样特征和显微镜下坏死显著相关（P≤0.05）。pT 分期或淋巴结转移有一定的相关性，但未达到统计学意义（分别为 P=0.05 和 0.06）。一种类似于最近提出的改良肿瘤分级方案、有丝分裂指数、细胞嗜酸性粒细胞和结构与预后无显著相关性。总之，嗜铬细胞瘤中肉瘤样分化相当罕见。肿瘤大小、小血管浸润、肉瘤样分化和显微镜下坏死是与不良预后显著相关的唯一特征。基于对大量病例的长期随访，嗜铬细胞瘤的临床结果似乎优于透明细胞和乳头状 RCC 报道的结果。
