Glickman Urological and Kidney Institute, Department of Urology, Cleveland Clinic, Cleveland, OH.
Robert J. Tomsich Pathology and Laboratory Medicine Institute, Department of Anatomic Pathology, Cleveland Clinic, Cleveland, OH.
Clin Genitourin Cancer. 2019 Jun;17(3):209-215.e1. doi: 10.1016/j.clgc.2019.03.004. Epub 2019 Mar 23.
Systematic pathology reviews in patients who experienced a clinical "recurrence" after partial nephrectomy for renal cell carcinoma (RCC) are anecdotal; therefore, definitions of "recurrence" varies considerably. We aimed to better define local recurrence by re-evaluation of surgical specimens of patients who experienced "recurrences" after partial nephrectomy at our institution.
Retrospective analysis of our institutional partial nephrectomy data set was performed. Patients who were clinically diagnosed with a local recurrence during the oncological follow-up after primary intervention for RCC were considered (January 2007 to December 2017, institutional review board number 5065, 15-1593). Re-evaluation of specimens coming from either primary treatment or management of the diagnosed recurrent disease was performed by 2 dedicated urologic pathologists. According to the findings of the pathology review, patients were assigned to 3 groups of disease event: (1) local recurrence of RCC; (2) new occurrence of RCC; and (3) micrometastatic RCC. Patient demographic characteristics, tumor pathological characteristics, oncological outcomes, disease treatment, and follow-up were reported for each patient. Cancer-specific survival was compared using the Kaplan-Meier method.
Of 1994 cases recorded in the institutional database, data on 30 patients who were clinically diagnosed with a local recurrence were extracted. After pathology review, 9 patients were found who truly developed a local recurrence (group 1). Positive surgical margin status was poorly related to the likelihood of a true local recurrence as defined herein. Twelve patients were assessed with a new occurrence of RCC (group 2). Nine were diagnosed with micrometastatic RCC (group 3). With comparable follow-up lengths among the groups (39 [interquartile range (IQR), 32-45] versus 51.5 [IQR, 35-90.5] versus 42 [IQR, 13-65], group 1 versus 2 versus 3, respectively; P = .4), patients classified in group 1 and 3 had comparable cancer-specific survival (P = .5). Conversely, patients in group 2 were less likely to die of disease compared with group 1 and 3 patients (P = .02).
Careful pathologic classification of RCC disease events after partial nephrectomy has important prognostic implications and allows more precise study of the clinical significance of margin status.
在接受肾细胞癌（RCC）部分肾切除术的患者中出现临床“复发”后，系统病理学检查仅是传闻；因此，“复发”的定义差异很大。我们旨在通过重新评估在我院经历“复发”的部分肾切除术患者的手术标本来更好地定义局部复发。
对我院部分肾切除术数据集进行回顾性分析。在对 RCC 进行初步干预后的肿瘤随访期间，临床诊断为局部复发的患者被认为是（2007 年 1 月至 2017 年 12 月，机构审查委员会编号 5065，15-1593）。由 2 名专门的泌尿科病理学家对来自初次治疗或诊断性复发性疾病治疗的标本进行重新评估。根据病理学检查结果，将患者分为 3 组疾病事件：（1）RCC 的局部复发；（2）新发生的 RCC；和（3）RCC 微转移。报告了每位患者的患者人口统计学特征，肿瘤病理特征，肿瘤学结果，疾病治疗和随访。使用 Kaplan-Meier 方法比较癌症特异性生存率。
在机构数据库中记录的 1994 例病例中，提取了 30 例临床诊断为局部复发的患者的数据。经过病理学检查，发现有 9 例患者确实发生了局部复发（第 1 组）。阳性手术切缘状态与本文定义的真正局部复发的可能性相关性较差。12 例患者被评估为新发生的 RCC（第 2 组）。9 例诊断为 RCC 微转移（第 3 组）。3 组之间的随访长度相当（组 1：39 [四分位距（IQR），32-45] 与组 2：51.5 [IQR，35-90.5] 与组 3：42 [IQR，13-65] ，分别为；P =.4），被分类为第 1 组和第 3 组的患者具有相似的癌症特异性生存率（P =.5）。相反，与第 1 组和第 3 组患者相比，第 2 组患者死于疾病的可能性较小（P =.02）。
对部分肾切除术后 RCC 疾病事件进行仔细的病理分类具有重要的预后意义，并允许更精确地研究切缘状态的临床意义。
