Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada; Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy.
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada; Urology Unit, ASST Spedali Civili of Brescia, Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy.
Clin Genitourin Cancer. 2020 Oct;18(5):e610-e618. doi: 10.1016/j.clgc.2020.02.001. Epub 2020 Feb 8.
We investigated the association between synchronous metastases (SMs), histologic subtype (HS), tumor size (TS), and tumor grade (TG) in surgically treated stage T2 renal cell carcinoma (RCC).
Within the Surveillance, Epidemiology, and End Results database (2005-2015), 8344 patients with T2 RCC who had undergone radical nephrectomy were identified. The SM rates were tabulated according to the HS, TG, and TS and tested in multivariable logistic regression models.
According to the HS, the average SM rates were 0%, 1.4%, 4.6%, 6.4%, 12.7%, 20.0%, and 32.7% for multilocular cystic, chromophobe, papillary, TG 1-2 clear cell, TG 3-4 clear cell, collecting duct, and sarcomatoid dedifferentiation RCC, respectively. In multivariable logistic regression models predicting for SMs, HS represented the strongest predictor, followed by TG, TS, and race. When combined, HS, TG, TS, and race predicted for SMs with 70.2% accuracy compared with 62.5% with HS, 60.2% with TG, 57.8% with TS, and 53.0% with race alone. Lung only was the most common metastatic site (43.6%), followed by bone only (27.6%), liver only (4.4%), and brain only (4.4%). Of all the patients with SMs, 78.9% had a single metastatic site.
The SM rates showed very wide variation according to the HS, TG, and TS. When HS was combined with TG, TS, and race, SMs could be accurately predicted in individual patients better than with TS alone. Thus, renal mass biopsy-derived HS and TG could improve the prediction of SMs compared with using TS alone.
我们研究了手术治疗的 T2 期肾细胞癌（RCC）中同步转移（SMs）、组织学亚型（HS）、肿瘤大小（TS）和肿瘤分级（TG）之间的关联。
在监测、流行病学和最终结果数据库（2005-2015 年）中，确定了 8344 例接受根治性肾切除术的 T2RCC 患者。根据 HS、TG 和 TS 列出 SM 发生率，并在多变量逻辑回归模型中进行测试。
根据 HS，多房囊性、嫌色细胞、乳头状、TG1-2 透明细胞、TG3-4 透明细胞、集合管和肉瘤样去分化 RCC 的平均 SM 发生率分别为 0%、1.4%、4.6%、6.4%、12.7%、20.0%和 32.7%。在预测 SMs 的多变量逻辑回归模型中，HS 是最强的预测因素，其次是 TG、TS 和种族。当结合使用时，HS、TG、TS 和种族可以预测 SMs 的准确率为 70.2%，而仅使用 HS、TG、TS 和种族分别为 62.5%、60.2%、57.8%和 53.0%。只有肺是最常见的转移部位（43.6%），其次是仅骨（27.6%）、仅肝（4.4%）和仅脑（4.4%）。在所有有 SMs 的患者中，78.9%的患者只有一个转移部位。
SM 发生率根据 HS、TG 和 TS 差异很大。当 HS 与 TG、TS 和种族相结合时，SMs 在个体患者中的预测准确率优于仅使用 TS。因此，与仅使用 TS 相比，肾肿瘤活检获得的 HS 和 TG 可以提高 SMs 的预测能力。
