Anatomical Pathology Unit, Department of Surgery and Pathology, Faculty of Medicine, University of Cordoba, Cordoba, Spain.
BJU Int. 2012 Sep;110(6):786-93. doi: 10.1111/j.1464-410X.2012.10934.x. Epub 2012 Mar 8.
What's known on the subject? and What does the study add? Unclassified RCC represents 0.7-5.7% of renal tumours. Limited reported data from two series suggests that unclassified RCC is an aggressive form of RCC, mainly because most cases are at an advanced stage at presentation, but overall and cancer-specific survival were not significantly different between unclassified and clear-cell RCC in an additional series of 38 patients. Our study of 56 cases of unclassified RCC describes the pathological features that can be applied to predict prognosis on a daily basis. In particular nuclear grade, TNM classification, tumour coagulative necrosis, tumour size, microvascular invasion and 2004 WHO histotype are independent predictors of disease-free and cancer-specific survival.
To evaluate the clinicopathological features and outcomes of 56 patients with unclassified renal cell carcinoma (RCC) meeting 2004 World Health Organization diagnostic criteria.
Urological pathology files of the participating institutions were reviewed and cases of unclassified RCC that met the inclusion criteria were retrieved. Nuclear grade, pT status, tumour size, regional lymph node involvement, distant metastases, coagulative tumour necrosis, mucin and sarcomatoid differentiation were evaluated in radical nephrectomy or nephron-sparing specimens. Significant factors in univariate analysis were then assessed by a multivariate analysis of independent prognostic factors using Cox proportional hazard regression analysis.
Fifty-six cases met the histological criteria for unclassified RCC. Thirty-four (61%) cases were categorized as unrecognizable cell type (mean overall survival 47 months; median 36 months), 20 (36%) as composites of recognized types (mean overall survival 36 months; median 26 months), and two (4%) (mean survival 16 months; median 16 months) as pure sarcomatoid morphology without recognizable epithelial elements. Cox multivariate analysis showed nuclear grade (P = 0.020), stage (P < 0.001), tumour coagulative necrosis (P = 0.018), tumour size (P < 0.001), microvascular invasion (P < 0.001) and tumour histotype (P = 0.028) to be independent predictors of disease-free survival, with tumour size being the most significant (hazard ratio [HR] 9.068, 95% confidence interval [CI] 3.231-25.453). Nuclear grade (P = 0.026), stage (P < 0.001), tumour coagulative necrosis (P < 0.001), tumour size (P = 0.044), microvascular invasion (P < 0.001), tumour recurrence after surgery (P < 0.001) and tumour histotype (P = 0.056) were independent predictors of cancer-specific survival, with tumour recurrence after surgery being the most significant (HR 14.713, 95% CI 5.329-40.622).
The prognosis of patients with unclassified RCC seems to be related to clinicopathological features known to be relevant in common forms of RCC.
关于这个主题，已知的内容是什么？本研究增加了什么新内容？未分类的 RCC 占肾肿瘤的 0.7-5.7%。来自两个系列的有限报告数据表明，未分类的 RCC 是一种侵袭性的 RCC 形式，主要是因为大多数病例在就诊时处于晚期，但在另外一组 38 例患者中，未分类和透明细胞 RCC 之间的总生存期和癌症特异性生存期没有显著差异。我们对 56 例未分类的 RCC 研究描述了可以应用于日常预测预后的病理特征。特别是核分级、TNM 分类、肿瘤凝固性坏死、肿瘤大小、微血管侵犯和 2004 年世卫组织组织学类型是疾病无进展和癌症特异性生存的独立预测因子。
评估 56 例符合 2004 年世界卫生组织诊断标准的未分类肾细胞癌（RCC）患者的临床病理特征和结局。
回顾参与机构的泌尿病理学档案，并检索符合纳入标准的未分类 RCC 病例。在根治性肾切除术或保肾手术标本中评估核分级、pT 状态、肿瘤大小、区域淋巴结受累、远处转移、肿瘤凝固性坏死、黏蛋白和肉瘤样分化。然后，通过 Cox 比例风险回归分析对单因素分析中的显著因素进行多因素分析，以评估独立预后因素。
56 例符合未分类 RCC 的组织学标准。34 例（61%）为无法识别细胞类型（总生存率 47 个月；中位数 36 个月），20 例（36%）为公认类型的组合（总生存率 36 个月；中位数 26 个月），2 例（4%）（平均生存 16 个月；中位数 16 个月）为纯肉瘤样形态，无可识别的上皮成分。Cox 多因素分析显示核分级（P = 0.020）、分期（P < 0.001）、肿瘤凝固性坏死（P = 0.018）、肿瘤大小（P < 0.001）、微血管侵犯（P < 0.001）和肿瘤组织学类型（P = 0.028）是无病生存率的独立预测因子，肿瘤大小是最显著的（风险比[HR]9.068，95%置信区间[CI]3.231-25.453）。核分级（P = 0.026）、分期（P < 0.001）、肿瘤凝固性坏死（P < 0.001）、肿瘤大小（P = 0.044）、微血管侵犯（P < 0.001）、手术后肿瘤复发（P < 0.001）和肿瘤组织学类型（P = 0.056）是癌症特异性生存率的独立预测因子，手术后肿瘤复发是最显著的（HR 14.713，95%CI 5.329-40.622）。
未分类 RCC 患者的预后似乎与常见 RCC 形式中已知与预后相关的临床病理特征有关。
