Beaugerie Aurélien, Audenet François, Verkarre Virginie, Delavaud Christophe, Le Guilchet Thomas, Hurel Sophie, de Saint Aubert Nicolas, Correas Jean-Michel, Fontaine Eric, Richard Stéphane, Méjean Arnaud, Timsit Marc-Olivier
Department of Urology, Hôpital Européen Georges Pompidou, AP-HP, Paris Descartes University, Paris, France.
Department of Urology, Hôpital Européen Georges Pompidou, AP-HP, Paris Descartes University, Paris, France.
Urol Oncol. 2018 Jan;36(1):11.e7-11.e12. doi: 10.1016/j.urolonc.2017.09.002. Epub 2017 Oct 6.
To evaluate the pathological concordance rate of multiple synchronous renal masses (MSRM) presumed to be sporadic and to analyze predictive factors of concordance.
We identified from our institutional database patients with sporadic MSRM treated at our center between January 2000 and December 2015. All tumors were reviewed by a dedicated uropathologist. Pathological concordance rate was analyzed regarding clinical characteristics and preoperative imaging.
We included 112 patients: 50 had unilateral synchronous renal masses and 62 bilateral synchronous renal masses. A total of 291 tumors were analyzed, with an average of 2.6 tumors per patient. Overall, the malignant concordance rate was 91.6%, the pathological concordance rate was 67.3% and the grade concordance rate was 62.5%. In univariate analysis, predictive factors of histological concordance were bilateral synchronous renal masses (odds ratio [OR] = 3.39; 95% CI: 1.06-10.8; P = 0.04), age<60 years (OR = 3.04; 95% CI: 1.2-7.7; P = 0.02) and ≥3 lesions (OR = 2.41; 95% CI: 1.03-5.68; P = 0.04). In multivariate analysis, age<60 remained significantly associated with histological concordance (OR = 3.84; 95% CI: 1.24-11.9; P = 0.02).
The histological concordance rate of MSRM is low. Age at diagnosis <60 years, bilateral lesions and ≥3 tumors are predictive factors of histological concordance, but the pathological diagnosis remains difficult to predict. This heterogeneity is important to take into account, particularly when choosing the treatment upon the renal biopsy results from a single lesion.
评估推测为散发性的多发性同步性肾肿块（MSRM）的病理一致性率，并分析一致性的预测因素。
我们从机构数据库中识别出2000年1月至2015年12月在本中心接受治疗的散发性MSRM患者。所有肿瘤均由一名专业泌尿病理学家进行复查。分析病理一致性率与临床特征及术前影像学的关系。
我们纳入了112例患者：50例有单侧同步性肾肿块，62例有双侧同步性肾肿块。共分析了291个肿瘤，平均每位患者2.6个肿瘤。总体而言，恶性一致性率为91.6%，病理一致性率为67.3%，分级一致性率为62.5%。在单因素分析中，组织学一致性的预测因素为双侧同步性肾肿块（比值比[OR]=3.39；95%可信区间：1.06 - 10.8；P = 0.04）、年龄<60岁（OR = 3.04；95%可信区间：1.2 - 7.7；P = 0.02）和≥3个病灶（OR = 2.41；95%可信区间：1.03 - 5.68；P = 0.04）。在多因素分析中，年龄<60岁仍与组织学一致性显著相关（OR = 3.84；95%可信区间：1.24 - 11.9；P = 0.02）。
MSRM的组织学一致性率较低。诊断时年龄<60岁、双侧病灶和≥3个肿瘤是组织学一致性的预测因素，但病理诊断仍难以预测。这种异质性很重要，尤其是在根据单个病灶的肾活检结果选择治疗方案时需要考虑。
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