Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Investig Clin Urol. 2018 Nov;59(6):357-362. doi: 10.4111/icu.2018.59.6.357. Epub 2018 Oct 4.
Classic angiomyolipoma (AML) is common benign kidney tumor. However, some studies have claimed that epithelioid angiomyolipoma (EAML) has malignant potential. We compared the patient characteristics and prognosis of EAML and classic AML to demonstrate predicting factors and poorer prognosis of EAML.
The medical records of 231 patients who were diagnosed with EAML (n=27, 11.7%) or classic AML (n=204, 88.3%), were reviewed. All patients underwent computed tomography (CT) scans before operation or needle biopsy. We assessed the age, sex, tumor size, body mass index, comorbidities, and Hounsfield unit (HU) according to each CT phase. We defined the unfavorable group as patients with recurrence, metastasis and death due to tumor progression. Logistic regression analysis was used to predict EAML.
EAML patients were younger (41.2 years vs. 49.1 years, p=0.001), predominantly male (55.6% vs. 28.4%, p=0.005), and had a larger tumor (7.5 cm vs. 4.2 cm, p<0.001). The median pre-contrast HU was not significantly different between EAML and classic AML (29.9±23.7 vs. 14.7±41.0, p=0.071). In multivariable analysis, younger age (odds ratio [OR], 0.96; p=0.032), male sex (OR, 3.33; p=0.013), and tumor larger than 4 cm (OR, 3.8; p=0.009) were significant predictive factors. Five patients (18.5%) had unfavorable outcomes, two patients had lymph node metastasis, and three patients had lung metastasis.
Patient and tumor characteristics can be helpful in determining the type of AML preoperatively. Younger age, male sex, and larger tumor mass may increase the possibility of diagnosing EAML. EAML has malignant potential and requires careful follow-up.
经典型血管平滑肌脂肪瘤(AML)是常见的良性肾脏肿瘤。然而,一些研究声称上皮样血管平滑肌脂肪瘤(EAML)具有恶性潜能。我们比较了 EAML 和经典 AML 的患者特征和预后,以证明 EAML 的预测因素和较差的预后。
回顾了 231 例被诊断为 EAML(n=27,11.7%)或经典 AML(n=204,88.3%)的患者的病历。所有患者均在手术前或经皮活检前行 CT 扫描。我们根据每个 CT 阶段评估年龄、性别、肿瘤大小、体重指数、合并症和 Hounsfield 单位(HU)。我们将不利组定义为因肿瘤进展而复发、转移和死亡的患者。使用逻辑回归分析预测 EAML。
EAML 患者更年轻(41.2 岁 vs. 49.1 岁,p=0.001),男性居多(55.6% vs. 28.4%,p=0.005),肿瘤更大(7.5 cm vs. 4.2 cm,p<0.001)。EAML 和经典 AML 的预对比 HU 中位数无显著差异(29.9±23.7 vs. 14.7±41.0,p=0.071)。多变量分析显示,年龄较小(比值比 [OR],0.96;p=0.032)、男性(OR,3.33;p=0.013)和肿瘤大于 4 cm(OR,3.8;p=0.009)是显著的预测因素。有 5 名患者(18.5%)出现不良结局,2 名患者发生淋巴结转移,3 名患者发生肺转移。
患者和肿瘤特征有助于术前确定 AML 的类型。年龄较小、男性和肿瘤体积较大可能增加诊断 EAML 的可能性。EAML 具有恶性潜能,需要仔细随访。