Salmasi Amirali, Faiena Izak, Lenis Andrew T, Pooli Aydin, Johnson David C, Drakaki Alexandra, Gollapudi Kiran, Blumberg Jeremy, Pantuck Allan J, Chamie Karim
Department of Urology, David Geffen School of Medicine at University of California, Los Angeles, CA; Institute of Urologic Oncology, David Geffen School of Medicine at University of California, Los Angeles, CA.
Department of Urology, David Geffen School of Medicine at University of California, Los Angeles, CA; Institute of Urologic Oncology, David Geffen School of Medicine at University of California, Los Angeles, CA.
Urol Oncol. 2018 Dec;36(12):527.e13-527.e19. doi: 10.1016/j.urolonc.2018.08.009. Epub 2018 Sep 15.
Although tumor tract seeding from renal mass biopsy (RMB) is exceedingly rare, the possibility of tumor capsule violation from RMB leading to perinephric fat invasion has not been quantified. We evaluated the association between RMB and perinephric fat invasion in patients with clinical T1a renal cell carcinoma who underwent partial or radical nephrectomy.
We reviewed the National Cancer Database from 2010-2013 and identified patients who underwent surgery for clinical T1a tumors. Patients were classified as upstaged only if final pathology demonstrated perinephric invasion only (pT3a). Mixed-effect logistic regression analysis was performed on inverse probability weighted matched groups to identify predictors of perinephric fat invasion. Multivariable Cox proportional hazards models and Kaplan-Meier survival curves were used to evaluate overall survival (OS).
A total of 24,548 patients met our inclusion criteria. Pathologic upstaging to pT3a perinephric fat involvement occurred in 1.2% of patients. This rate of upstaging was 1.1% in the no biopsy group compared with 2.1% in patients who underwent RMB (P < 0.01). In multivariable logistic model, RMB was associated with pT3a perinephric fat upstaging (OR 1.69, 95% CI 1.17-2.44, P < 0.01). Upstaging to pT3a was also associated with worse OS (HR 1.71, 95% CI 1.13-2.60, P = 0.01). Kaplan-Meier survival curves demonstrated similar OS estimates in patients upstaged to pT3a disease, irrespective of undergoing RMB or not (Log-Rank = 0.87).
RMB was associated with increased rate of upstaging to pT3a perinephric fat involvement in clinical T1a RCC. This effect is small with unclear clinical significance. This is perhaps balanced by the importance of the information acquired from biopsies. Future studies are needed to elucidate clinical significance of this finding.
尽管肾肿块活检（RMB）导致肿瘤种植极为罕见，但RMB造成肿瘤包膜破裂进而导致肾周脂肪浸润的可能性尚未得到量化。我们评估了接受部分或根治性肾切除术的临床T1a期肾细胞癌患者中，RMB与肾周脂肪浸润之间的关联。
我们回顾了2010 - 2013年的国家癌症数据库，确定了接受临床T1a期肿瘤手术的患者。仅当最终病理显示仅存在肾周浸润（pT3a）时，患者才被分类为分期上调。对逆概率加权匹配组进行混合效应逻辑回归分析，以确定肾周脂肪浸润的预测因素。使用多变量Cox比例风险模型和Kaplan-Meier生存曲线来评估总生存期（OS）。
共有24,548例患者符合我们的纳入标准。1.2%的患者病理分期上调至pT3a肾周脂肪受累。在未进行活检的组中，这种分期上调率为1.1%，而接受RMB的患者为2.1%（P < 0.01）。在多变量逻辑模型中，RMB与pT3a肾周脂肪分期上调相关（OR 1.69，95% CI 1.17 - 2.44，P < 0.01）。分期上调至pT3a也与较差的OS相关（HR 1.71，95% CI 1.13 - 2.60，P = 0.01）。Kaplan-Meier生存曲线显示，分期上调至pT3a疾病的患者，无论是否接受RMB，OS估计相似（对数秩 = 0.87）。
在临床T1a期肾细胞癌中，RMB与pT3a肾周脂肪受累分期上调率增加相关。这种影响较小，临床意义不明确。这可能与活检所获信息的重要性相平衡。需要进一步研究来阐明这一发现的临床意义。
