Department of Pathology and Laboratory Medicine and Henry Ford Cancer Institute, Henry Ford Health System, Detroit, MI, USA.
Department of Pathology and Laboratory Medicine, Wayne State University School of Medicine, Detroit, MI, USA.
Histopathology. 2019 Jan;74(1):18-30. doi: 10.1111/his.13743.
Renal cell carcinoma (RCC) is unusual among cancers in that it often grows as a spherical, well-circumscribed mass. Increasing tumour size influences the pathological pT stage category within pT1 and pT2, with cutoffs of 40, 70 and 100 mm; however, with increasing size also comes a sharp increase in the likelihood of renal sinus or renal vein tributary invasion, such that clear cell RCC rarely reaches 70 mm without invading one of these. To clarify some previous challenges in assigning tumour stage, the American Joint Committee on Cancer 2016 tumor-node-metastasis classification has removed the requirements than vein invasion be recognised grossly and that vein walls contain muscle for the diagnosis of vein invasion. Renal pelvis invasion has also been added as an additional route to pT3a. Multinodularity or finger-like extensions from a renal mass should be viewed with great suspicion for the possibility of vein or renal sinus invasion, and, as tumour size increases to over 40-50 mm, thorough sampling of the renal sinus interface should always be undertaken. With increasing interest in adjuvant therapy in renal cancer, the pathologist's role in RCC staging will continue to be an important prognostic parameter and a tool for selection of patients for enrolment in clinical trials.
肾细胞癌（RCC）在癌症中较为特殊，其常呈球形、边界清楚的肿块生长。肿瘤大小的增加会影响 pT1 和 pT2 中病理 pT 分期类别，其界限分别为 40、70 和 100mm；然而，随着肿瘤大小的增加，肾窦或肾静脉属支侵犯的可能性也会急剧增加，因此，透明细胞 RCC 很少能长到 70mm 而不侵犯其中之一。为了阐明肿瘤分期方面的一些先前挑战，美国癌症联合委员会 2016 年肿瘤-淋巴结-转移分类已删除了静脉侵犯必须肉眼识别以及静脉壁含有肌肉才能诊断静脉侵犯的要求。肾盂侵犯也被添加为 pT3a 的另一种途径。对于来自肾肿块的多结节性或指状延伸，应高度怀疑静脉或肾窦侵犯的可能性，并且随着肿瘤大小增加到 40-50mm 以上，应始终对肾窦界面进行彻底取样。随着对肾癌辅助治疗的兴趣增加，病理学家在 RCC 分期中的作用将继续成为一个重要的预后参数，并作为选择患者入组临床试验的工具。
