Department of Genitourinary Oncology, Tianjin Medical University Cancer Institute & Hospital, Tianjin, China.
Urology. 2012 Apr;79(4):836-9. doi: 10.1016/j.urology.2011.11.023. Epub 2012 Feb 2.
To determine the optimal surgical margins in nephron-sparing surgery (NSS) for T1b renal cell carcinomas (RCC).
We retrospectively assessed 87 T1b RCC specimens after radical nephrectomy through whole-kidney continuous sections, with 92 T1a RCCs included as controls. The completeness of pseudocapsule (PS) and extra-PS lesions and multifocality were microscopically examined, as was the greatest distance between extra-PS lesions and primary tumors.
The rates of incomplete PS (34% [30/87] vs 18% [17/92], P = .015) and positive cancer lesions beyond the PS (39% [34/87] vs 25% [23/92], P = .043) were significantly higher in the T1b than in the T1a group. All extra-PS lesions were located within 3.0 mm of the primary tumor. Multifocal tumors were found in 6% (5/87) of patients with T1b and 5% (5/92) of patients with T1a tumors (P = .928).
These results indicate that 4 mm may be the optimal surgical margin for NSS for patients with T1b RCC because all extra-PS lesions were located within 3 mm of the primary tumors.
确定肾部分切除术（NSS）中 T1b 肾细胞癌（RCC）的最佳手术切缘。
我们通过全肾连续切片对 87 例根治性肾切除术后的 T1b RCC 标本进行回顾性评估，同时纳入 92 例 T1a RCC 作为对照。显微镜下检查假包膜（PS）和 PS 外病变的完整性以及多灶性，并检查 PS 外病变与原发性肿瘤之间的最大距离。
T1b 组 PS 不完全（34%[30/87]比 18%[17/92]，P=.015）和 PS 外癌病变阳性（39%[34/87]比 25%[23/92]，P=.043）的比例明显高于 T1a 组。所有 PS 外病变均位于原发性肿瘤 3.0mm 范围内。T1b 组有 6%（5/87）的患者有多灶性肿瘤，T1a 组有 5%（5/92）的患者有多灶性肿瘤（P=.928）。
这些结果表明，对于 T1b RCC 患者，4mm 可能是 NSS 的最佳手术切缘，因为所有 PS 外病变均位于原发性肿瘤 3mm 范围内。
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