Department of Urology, Huashan Hospital, Fudan University, 12 Central Urumqi Rd, Shanghai 200040, PR China.
Ann Diagn Pathol. 2012 Jun;16(3):190-5. doi: 10.1016/j.anndiagpath.2011.10.002. Epub 2011 Dec 30.
To explore the rationale for renal-sparing surgery as an alternative method to radical nephrectomy in the treatment of renal cell carcinoma (RCC), we analyzed clinical data from 94 patients diagnosed as having RCC. They were divided into 3 groups based on the maximum diameter of their tumor specimens. Group A had tumors size ranging from 0 to 4 cm, group B had tumors size ranging from 4 to 7 cm, and group C had tumors size greater than 7 cm. Tissue samples (5 cm) were taken from the upper pole side, lower pole side, and renal pelvic side of the tumor pseudocapsule; if the tumor was located on 1 pole of the kidney, samples were collected from 2 directions. The specimens were then embedded in paraffin and cut serially at segments 0 to 1, 1 to 3, and 3 to 5 cm. Staining with hematoxylin and eosin, anti-pancytokeratin, and vimentin was performed to determine tumor type and tumor infiltration. From the 94 patients analyzed, 2 patients in group A had RCC metastasis within 1 cm of tissue around the pseudocapsule, and 4 patients in groups B and C had lymph node metastasis without metastasis in the tissue 1 cm outside the pseudocapsule in all 3 directions described. There was no statistical significant difference found between the incidence of local metastasis of the various tumor sizes, suggesting that local metastasis of RCC is not associated with the size of the tumor. Based on the observation that incidences of local metastasis were low in early-stage RCC, we came to the conclusion that pseudocapsule of RCC tumor might have growth-limiting effect on the tumor enclosed. It is theoretically a safer and better surgical option for patients with RCC with a smaller size of tumor and indications for radical nephrectomy to undergo renal-sparing surgery with an excision margin of 1 cm of normal tissue around the pseudocapsule of the tumor.
为了探索保留肾单位手术作为治疗肾细胞癌（RCC）的根治性肾切除术的替代方法的基本原理，我们分析了 94 例诊断为 RCC 的患者的临床资料。根据肿瘤标本的最大直径将他们分为 3 组。A 组肿瘤直径为 0 至 4cm，B 组肿瘤直径为 4 至 7cm，C 组肿瘤直径大于 7cm。从肿瘤假包膜的上极侧、下极侧和肾盂侧取组织样本（5cm）；如果肿瘤位于肾脏的 1 极，则从 2 个方向取样本。然后将标本包埋在石蜡中，并在 0 至 1cm、1 至 3cm 和 3 至 5cm 处连续切片。使用苏木精和伊红、抗细胞角蛋白和波形蛋白进行染色，以确定肿瘤类型和肿瘤浸润情况。在分析的 94 例患者中，A 组有 2 例患者在假包膜周围 1cm 的组织中有 RCC 转移，B 组和 C 组各有 4 例患者在假包膜的 3 个方向均无淋巴结转移，但在假包膜外 1cm 的组织中有转移。不同肿瘤大小的局部转移发生率无统计学显著差异，提示 RCC 的局部转移与肿瘤大小无关。基于早期 RCC 局部转移发生率较低的观察结果，我们得出结论，RCC 肿瘤的假包膜可能对所包含的肿瘤具有生长限制作用。对于肿瘤较小且符合根治性肾切除术适应证的 RCC 患者，行肿瘤假包膜周围 1cm 正常组织切除的保留肾单位手术是一种更安全、更好的手术选择。
