pT1b 期肾肿瘤的组织病理学分析，以优化保肾手术的切缘。

Histopathologic analysis of stage pT1b kidney neoplasms for optimal surgical margins of nephron-sparing surgery.

机构信息

Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, No. 23, Pingjiang Rd, Tianjin, 300211, China.

Department of Pathology, Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China.

出版信息

Clin Transl Oncol. 2018 Sep;20(9):1196-1201. doi: 10.1007/s12094-018-1845-0. Epub 2018 Mar 21.

DOI:10.1007/s12094-018-1845-0

PMID:29564715

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6105239/

Abstract

OBJECTIVE

To evaluate the pathological features and define the optimal surgical margins (SM) of nephron-sparing surgery (NSS) for kidney neoplasms 4-7 cm (stage pT1b) on preoperative imaging.

MATERIALS AND METHODS

The retrospective study included 748 patients who were diagnosed stage pT1b renal tumors and underwent either radical nephrectomy (RN, n = 475) or NSS (n = 273) from January 2004 to March 2017. The tumor size, pathological subtype, Fuhrman grade, status of peritumoral pseudocapsule (PC) and tumor multifocality were recorded. The relationship between peritumoral PC and positive SM was calculated statistically by Fisher's exact probability test.

RESULTS

The mean tumor diameter was 5.4 cm (range: 4.1-7.0 cm), 65 (8.7%) cases were discovered with multifocal lesions and 686 (91.7%) were surrounded with peritumoral PC in all 748 specimens. 57 (8.3%) of 686 cases were proved with tumor infiltrated beyond PC [infiltration (+)], and the presence of PC infiltration (+) was significantly correlated with positive SM (p = 0.016). The infiltrative depth of tumor cells into renal parenchyma beyond PC was all limited in 3 mm and the proportion of ≤ 1, 1-2 and 2-3 mm was 21.1% (12/57), 59.6% (34/57) and 19.3% (11/57), respectively.

CONCLUSIONS

Our report indicates a 3 mm excisional margin is acceptable to ensure negative SM when operating NSS on stage pT1b kidney neoplasms.

摘要

目的

评估术前影像学检查诊断为 4-7cm（pT1b 期）肾肿瘤患者行保留肾单位手术（NSS）的病理特征，并确定最佳手术切缘（SM）。

材料与方法

本回顾性研究纳入了 2004 年 1 月至 2017 年 3 月期间接受根治性肾切除术（RN）（n=475）或 NSS（n=273）治疗的 748 例 pT1b 期肾肿瘤患者。记录肿瘤大小、病理亚型、Fuhrman 分级、肿瘤假包膜（PC）状态和肿瘤多灶性。采用 Fisher 确切概率检验统计分析肿瘤假包膜与阳性 SM 之间的关系。

结果

肿瘤平均直径为 5.4cm（范围：4.1-7.0cm），65 例（8.7%）为多发病灶，686 例（91.7%）肿瘤周围有肿瘤假包膜。57 例（8.3%）证实肿瘤侵犯肿瘤假包膜（浸润（+）），肿瘤假包膜浸润（+）与阳性 SM 显著相关（p=0.016）。肿瘤细胞向肿瘤假包膜外肾实质浸润的深度均局限于 3mm，≤1mm、1-2mm 和 2-3mm 的比例分别为 21.1%（12/57）、59.6%（34/57）和 19.3%（11/57）。