Department of Urology, Singapore General Hospital, Singapore.
Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Int J Urol. 2020 May;27(5):439-447. doi: 10.1111/iju.14219. Epub 2020 Mar 23.
To evaluate variables that can predict synchronous metastasis in patients presenting with small renal masses.
We reviewed our institution's prospectively maintained database of 565 patients diagnosed with small renal masses (≤4 cm) over a 16-year period. Variables associated with synchronous metastasis and subsequent relapse were analyzed using χ and logistic regression models.
A total of 16 patients (2.7%) presented with synchronous metastasis. Just three patients with tumor size <3 cm had metastatic disease at presentation. On multivariate analyses, tumor size >3 cm, symptomatic cancer, age >65 years and ipsilateral synchronous tumors were independent predictors of M1 renal cell carcinoma. A weighted predictive model (concordance index 0.786) showed that a score ≥2 significantly increases the risk of synchronous metastasis (7.9% vs <1% for score <2, P < 0.01, hazard ratio 12.56, 95% confidence interval 5.52-22.85). A total of 498 (90.7%) patients underwent nephrectomies, 27 (4.9%) had ablative therapies and 24 (4.4%) continued on active surveillance/watchful waiting. Over a median follow-up period of 62.8 months, 30 patients (6.1%) had disease recurrence. On multivariate analyses, higher Fuhrman grade and lymphovascular invasion were independent predictors of recurrence. A separate predictive model (concordance index 0.723) showed that either pathological outcome increases recurrence risk up to 15% (P < 0.01, hazard ratio 11.83, 95% confidence interval 5.82-18.76).
Several clinical variables can better identify the metastatic potential of small renal masses. The two proposed predictive models can be valuable tools in future clinical practice.
评估可预测同时性转移的变量，这些变量存在于表现为小肾肿块的患者中。
我们回顾了我们机构在 16 年期间前瞻性维护的数据库，其中包含 565 例诊断为小肾肿块（≤4cm）的患者。使用 χ 和逻辑回归模型分析与同步转移和随后复发相关的变量。
共有 16 名患者（2.7%）出现同步转移。仅有 3 名肿瘤大小<3cm 的患者在初诊时就有转移疾病。多变量分析显示，肿瘤大小>3cm、症状性癌症、年龄>65 岁和同侧同步肿瘤是 M1 肾细胞癌的独立预测因素。一个加权预测模型（一致性指数 0.786）显示，评分≥2 显著增加了同步转移的风险（评分<2 的为 7.9%，<1%，P<0.01，危险比 12.56，95%置信区间 5.52-22.85）。共有 498 名（90.7%）患者接受了肾切除术，27 名（4.9%）接受了消融治疗，24 名（4.4%）继续进行积极监测/观察等待。在中位随访 62.8 个月期间，有 30 名患者（6.1%）出现疾病复发。多变量分析显示，更高的 Fuhrman 分级和脉管侵犯是复发的独立预测因素。一个单独的预测模型（一致性指数 0.723）显示，任何病理结果都会使复发风险增加 15%（P<0.01，危险比 11.83，95%置信区间 5.82-18.76）。
一些临床变量可以更好地识别小肾肿块的转移潜力。这两个提出的预测模型可以成为未来临床实践中的有用工具。
