Lu Qun, Ji Changwei, Zhao Xiaozhi, Fu Yao, Guo Suhan, Liu Guangxiang, Zhang Shiwei, Li Xiaogong, Gan Weidong, Guo Hongqian
Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, Nanjing, Jiangsu, People׳s Republic of China.
Department of Pathology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, People׳s Republic of China.
Urol Oncol. 2017 Oct;35(10):603.e15-603.e20. doi: 10.1016/j.urolonc.2017.05.017. Epub 2017 Jun 12.
This study was designed to assess the feasibility and histopathologic safety of tumor enucleation for renal cell carcinoma, through histopathologic analysis of the tumor bed and peritumoral pseudocapsule (PC) after in vitro tumor enucleation.
We studied 176 radical nephrectomy specimens for clinical T1b renal cell carcinoma in our institution, from January 2013-February 2016. Immediately after the kidney was excised, the tumor of radical specimen was enucleated in vitro. The tumor bed parenchyma of 15mm beyond the PC was examined to investigate the possible presence of tumor invasion or satellite lesions. The PC invasion was also evaluated.
The average tumor size was 5.7±0.7cm. The histopathologic evaluation revealed that 68.2% of tumors were clear cell renal cell carcinoma (RCC). The pathological staging showed that 92.6% of tumors were pT1b, 2.8% were pT2, and 4.5% were pT3a. For clinical T1b RCC, tumor infiltration on tumor bed was detected in 6 cases (3.4%), and satellite lesion was detected in 3 (1.7%). In the group of grade 1 to 2, 4 (2.3%) were found with residual tumor, and 5 (2.8%) in the group of grade 3 to 4 (P = 0.133). Papillary RCC had the highest rate of residual tumors (8.8%). A statistically significant association of peritumoral PC invasion with tumor size and pathologic grade was observed. Median follow-up was 23 months (range: 6-43) with a recurrence rate of 6.3% (11 of 176) and a cancer-specific mortality rate of 2.8% (5 of 176).
For clinical T1b renal cell carcinoma, the risks of tumor infiltration or satellite lesions on enucleation tumor bed or both are relatively low. Peritumoral PC invasion is associated with tumor size and pathologic stage. Tumor enucleation is a histopathologically safe technique for patients undergoing partial nephrectomy.
本研究旨在通过对体外肿瘤剜除术后肿瘤床和肿瘤周围假包膜（PC）进行组织病理学分析，评估肾细胞癌肿瘤剜除术的可行性和组织病理学安全性。
我们研究了2013年1月至2016年2月间本机构176例临床T1b期肾细胞癌的根治性肾切除标本。肾脏切除后立即在体外将根治性标本中的肿瘤剜除。检查PC外15mm的肿瘤床实质，以调查是否存在肿瘤侵犯或卫星灶。同时评估PC侵犯情况。
肿瘤平均大小为5.7±0.7cm。组织病理学评估显示，68.2%的肿瘤为透明细胞肾细胞癌（RCC）。病理分期显示，92.6%的肿瘤为pT1b，2.8%为pT2，4.5%为pT3a。对于临床T1b期RCC，6例（3.4%）肿瘤床发现肿瘤浸润，3例（1.7%）发现卫星灶。1至2级组中，4例（2.3%）发现有残留肿瘤，3至4级组中5例（2.8%）发现有残留肿瘤（P = 0.133）。乳头状RCC的残留肿瘤率最高（8.8%）。观察到肿瘤周围PC侵犯与肿瘤大小和病理分级存在统计学显著关联。中位随访时间为23个月（范围：6 - 43个月），复发率为6.3%（176例中的11例），癌症特异性死亡率为2.8%（176例中的5例）。
对于临床T1b期肾细胞癌，肿瘤剜除术肿瘤床出现肿瘤浸润或卫星灶或两者的风险相对较低。肿瘤周围PC侵犯与肿瘤大小和病理分期相关。肿瘤剜除术对于接受部分肾切除术的患者是一种组织病理学安全的技术。
