Tay Melissa H W, Thamboo Thomas P, Wu Fiona M W, Zhaojin Chen, Choo Tai Bee, Ramaan Lata, Tiong Ho Yee
1 Department of Urology, National University Health System , Singapore .
J Endourol. 2014 Sep;28(9):1138-42. doi: 10.1089/end.2014.0123. Epub 2014 Jun 24.
The R.E.N.A.L. Nephrometry Score (RNS) was developed to standardize the reporting of anatomic information of a renal mass. This study aimed to identify the association of preoperative clinical and tumor features assessed by the RNS with pathologic upstaging of clinical T1 renal-cell carcinomas (RCCs) in complete en bloc radical nephrectomy (RN) specimens.
A review was performed for 65 consecutive patients (2005-2013) who underwent RNs for a unilateral clinical T1N0M0 RCC. The RNS was measured in all patients based on preoperative CT scans. Pathologic review was performed to identify patients with final pathologic upstaging. Associations were assessed with the Fisher exact test, Student t test, and Wilcoxon rank sum test.
Of the 65 patients (41 male, mean age 59 years), 4 (6%) patients were upstaged to pT2 and 16 (25%) were upstaged to pT3a and above in the final histologic evaluation. Upstaged patients were not significantly different from those without in terms of age, sex, race, surgical approach, side of surgery, Fuhrman grade, and histologic cell type. Independent tumor features associated with pathologic upstaging were (R) tumor diameter (P=0.021), and (L) central location within polar lines (P=0.010). Tumors that were upstaged had a higher median total RNS than those without (10 vs 9, P=0.010). Complex tumors, with RNS≥10, were associated with significantly increased risk of upstaging compared with low and intermediate complexity categories (RNS<10) (relative risk=2.56, 95% confidence interval 1.22-5.37, P=0.014).
A higher RNS was associated with an increased risk of upstaging in clinical T1 cancers, predominantly from perinephric or sinus fat invasion in RN pathologic specimens. This may have implications on the selection of surgical option for the clinical T1 renal mass.
研发R.E.N.A.L.肾计量评分（RNS）是为了规范肾肿块解剖信息的报告。本研究旨在确定通过RNS评估的术前临床和肿瘤特征与根治性肾切除术（RN）完整整块标本中临床T1期肾细胞癌（RCC）病理分期上调之间的关联。
对连续65例（2005 - 2013年）因单侧临床T1N0M0 RCC接受RN手术的患者进行回顾性研究。根据术前CT扫描对所有患者测量RNS。进行病理检查以确定最终病理分期上调的患者。采用Fisher精确检验、Student t检验和Wilcoxon秩和检验评估关联。
65例患者（41例男性，平均年龄59岁）中，4例（6%）患者在最终组织学评估中分期上调至pT2，16例（25%）患者分期上调至pT3a及以上。分期上调的患者在年龄、性别、种族、手术方式、手术侧别、Fuhrman分级和组织学细胞类型方面与未上调的患者无显著差异。与病理分期上调相关的独立肿瘤特征为（R）肿瘤直径（P = 0.021）和（L）极线内的中央位置（P = 0.010）。分期上调的肿瘤中位总RNS高于未上调的肿瘤（10对9，P = 0.010）。与低和中等复杂程度类别（RNS < 10）相比，RNS≥10的复杂肿瘤分期上调风险显著增加（相对风险 = 2.56，95%置信区间1.22 - 5.37，P = 0.014）。
较高的RNS与临床T1期癌症分期上调风险增加相关，主要源于RN病理标本中的肾周或窦脂肪浸润。这可能对临床T1期肾肿块手术方式的选择有影响。
