Zhu Dongsheng, Cao Jingyuan, Zhi Chao, Guo Tao, Li Yuhong, Lang Zhiqiang, Li Gang
Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin 300211, P.R. China.
Department of Urology, Binzhou Medical University Hospital, Binzhou, Shandong 256600, P.R. China.
Oncol Lett. 2020 Mar;19(3):1721-1726. doi: 10.3892/ol.2020.11281. Epub 2020 Jan 9.
In the current Tumor-Node-Metastasis (TNM) classification system for renal cell carcinoma (RCC), both perinephric fat invasion (PFI) and renal sinus fat invasion (SFI) are classified at the T3a stage. However, their associated prognoses are clinically controversial. The present study proposes a new sub-classification criterion for pathological T3a (pT3a) RCC with SFI or PFI to resolve this dispute. Data were collected from consecutive records of 2,765 patients with T1a renal cancer, who had undergone partial nephrectomy (PN) between 2001 and 2015 at one of four hospitals. Among these patients, 127 cases were diagnosed with stage pT3a RCC with SFI or PFI, according to final pathological examination. The pathological characteristics, clinical data and follow-up observations were analyzed. Of the 127 patients, with an average follow-up duration of 56 months (range, 15-60 months), 17 cases of tumor recurrence were found. After analysis of the pathological findings, the following new sub-classification criteria was proposed for pT3a RCC with SFI or PFI: i) Type A, renal tumor invades the pseudo-capsule and contacts with the perinephric adipose tissues directly (3 recurrences out of 57 patients); ii) type B, tumor protrudes into the perinephric adipose tissues like a tongue (4 recurrences out of 29 patients); and iii) type C, tumor nodules distribute in perinephric adipose tissues (10 recurrences out of 41 patients). There was statistically significant difference between the three subtypes in terms of recurrence rate (P=0.023). In conclusion, controversies remain in the current TNM classification system for pT3a RCC. The present study added to the available data and found that pT3a RCC with tumor nodules in perinephric adipose or/and with an irregular tumor protruding into adipose tissues showed a higher recurrence rate. Thus, it is recommended that pT3a RCC should be carefully analyzed and should be considered differently to other stages of RCC.
在当前用于肾细胞癌（RCC）的肿瘤-淋巴结-转移（TNM）分类系统中，肾周脂肪浸润（PFI）和肾窦脂肪浸润（SFI）均被归类为T3a期。然而，它们相关的预后在临床上存在争议。本研究提出了一种针对伴有SFI或PFI的病理T3a（pT3a）RCC的新亚分类标准，以解决这一争议。数据收集自2001年至2015年期间在四家医院之一接受了部分肾切除术（PN）的2765例T1a期肾癌患者的连续记录。在这些患者中，根据最终病理检查，有127例被诊断为伴有SFI或PFI的pT3a期RCC。对其病理特征、临床数据和随访观察进行了分析。127例患者的平均随访时间为56个月（范围15 - 60个月），发现17例肿瘤复发。在对病理结果进行分析后，针对伴有SFI或PFI的pT3a RCC提出了以下新的亚分类标准：i）A型，肾肿瘤侵犯假包膜并直接与肾周脂肪组织接触（57例患者中有３例复发）；ii）B型：肿瘤如舌状突入肾周脂肪组织（29例患者中有4例复发）；iii）C型：肿瘤结节分布于肾周脂肪组织中（41例患者中有10例复发）。三种亚型在复发率方面存在统计学显著差异（P = 0.023）。总之，当前pT3a RCC的TNM分类系统仍存在争议。本研究补充了现有数据，发现肾周脂肪中有肿瘤结节或/和有不规则肿瘤突入脂肪组织的pT3a RCC显示出较高的复发率。因此，建议对pT3a RCC应仔细分析，并应与RCC的其他阶段区别考虑。
