Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas.
Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas.
J Urol. 2016 Aug;196(2):321-6. doi: 10.1016/j.juro.2016.02.068. Epub 2016 Feb 13.
The overall incidence of pulmonary metastasis of T1 renal cell carcinoma is low. We evaluated the usefulness of chest x-rays based on the current AUA (American Urological Association) guidelines and NCCN Guidelines® for T1a renal cell carcinoma surveillance.
Between 2006 and 2012, 258 patients with T1a renal cell carcinoma were treated with partial nephrectomy, radical nephrectomy or radio frequency ablation with surveillance followup at our institution. A retrospective chart review was performed to identify demographics, pathological findings and surveillance records. The primary outcome was the incidence of asymptomatic pulmonary recurrences diagnosed by chest x-ray in cases of T1a disease. Our secondary outcome was a comparison of diagnoses by treatment modality (partial nephrectomy, radical nephrectomy or radio frequency ablation).
Pulmonary metastases developed in 3 of 258 patients (1.2%) but only 1 (0.4%) was diagnosed by standard chest x-ray surveillance. Median followup in the entire cohort was 36 months (range 6 to 152) and 193 of 258 patients (75%) had greater than 24 months of followup. A mean of 3.3 surveillance chest x-rays were completed per patient. When assessed by treatment type, there was no significant difference in the recurrence rate for partial nephrectomy (0 of 191 cases), radical nephrectomy (0 of 22) or radio frequency ablation (1 of 45 or 2.2%) (p = 0.09).
Chest x-rays are a low yield diagnostic tool for detecting pulmonary metastasis in patients treated for T1a renal cel carcinoma. Treatment mode does not appear to influence the need for chest x-ray surveillance.
T1 期肾细胞癌的肺转移总体发生率较低。我们评估了现行 AUA（美国泌尿外科学会）指南和 NCCN 指南®对 T1a 期肾细胞癌监测中胸部 X 射线的应用价值。
2006 年至 2012 年，我们机构对 258 例 T1a 期肾细胞癌患者行部分肾切除术、根治性肾切除术或射频消融术治疗，并进行随访监测。我们对患者的人口统计学、病理发现和监测记录进行了回顾性图表分析。主要结局为 T1a 期疾病患者通过胸部 X 射线诊断无症状性肺复发的发生率。次要结局为通过治疗方式（部分肾切除术、根治性肾切除术或射频消融术）比较诊断结果。
3 例（1.2%）258 例患者发生肺转移，但仅 1 例（0.4%）通过标准胸部 X 射线监测诊断。全队列的中位随访时间为 36 个月（6 至 152 个月），258 例患者中有 193 例（75%）的随访时间大于 24 个月。平均每位患者完成了 3.3 次监测性胸部 X 射线检查。按治疗类型评估时，部分肾切除术（191 例中无 0 例）、根治性肾切除术（22 例中无 0 例）或射频消融术（45 例中有 1 例或 2.2%）的复发率无显著差异（p = 0.09）。
胸部 X 射线对检测 T1a 期肾细胞癌患者的肺转移是一种低检出率的诊断工具。治疗方式似乎并不影响胸部 X 射线监测的需求。
