Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA.
Int Urol Nephrol. 2012 Oct;44(5):1319-24. doi: 10.1007/s11255-012-0207-z. Epub 2012 Jun 9.
Gender, smoking history, patient age, and tumor size have been found to impact the likelihood of benign histology at the time of nephron-sparing surgery (NSS). Providing external validation of these variables and evaluating the relationship between body mass index (BMI) and tumor location on the likelihood of benign histology during NSS for T1 tumors were the objectives of this study.
Data were analyzed for consecutive patients undergoing NSS for T1 disease. Central tumors either were completely encircled by renal parenchyma, descended below the cortico-medullary junction, or were in direct opposition to the collecting system, renal sinus, or the hilar structures. Categorical variables were evaluated with chi-square test, and continuous variables were analyzed with independent sample t test. Logistic regression identified independent predictors of final pathology.
NSS was performed in 316 patients, of whom 79 (24 %) had benign tumors. Patients with benign tumors were more likely to be female, to have a lower BMI, and to have peripheral tumors. On multivariate analysis, female gender (hazard ratio, 3.97; 95 % CI, 2.92-4.53, p < 0.001), peripheral tumor location (hazard ratio, 2.27; 95 % CI, 1.73-3.21, p = 0.014), and lower BMI (hazard ratio, 1.5; 95 % CI, 1.12-1.94, p = 0.015) were independently associated with benign histopathology at the time of surgical resection.
Prospectively identifying which T1 tumors are benign would have tremendous implications for the patient. Ours is the first study that has identified the impact of tumor location and BMI on the risk of benign histology. Additional studies are needed to corroborate these findings and incorporate these data into future nomograms.
性别、吸烟史、患者年龄和肿瘤大小已被发现会影响保肾手术（NSS）时良性组织学的可能性。本研究的目的是为这些变量提供外部验证，并评估 T1 肿瘤行 NSS 时 BMI 和肿瘤位置与良性组织学之间的关系。
对连续接受 T1 疾病 NSS 治疗的患者进行数据分析。中央肿瘤要么完全被肾实质包围，要么下降到皮质-髓质交界处以下，要么直接与集合系统、肾窦或 hilar 结构相对。使用卡方检验评估分类变量，使用独立样本 t 检验分析连续变量。逻辑回归确定最终病理的独立预测因子。
316 例患者行 NSS，其中 79 例（24%）为良性肿瘤。良性肿瘤患者更可能为女性，BMI 更低，且肿瘤位于周边部位。多因素分析显示，女性性别（风险比，3.97；95%可信区间，2.92-4.53，p<0.001）、肿瘤位于周边（风险比，2.27；95%可信区间，1.73-3.21，p=0.014）和 BMI 较低（风险比，1.5；95%可信区间，1.12-1.94，p=0.015）与手术切除时的良性组织学独立相关。
前瞻性地确定哪些 T1 肿瘤是良性的，对患者具有重要意义。我们的研究首次确定了肿瘤位置和 BMI 对良性组织学风险的影响。需要进一步的研究来证实这些发现，并将这些数据纳入未来的列线图中。
