1Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada.
2Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy.
J Natl Compr Canc Netw. 2020 Oct 1;18(10):1340-1347. doi: 10.6004/jnccn.2020.7577. Print 2020 Oct.
The NCCN Clinical Practice Guidelines in Oncology for Kidney Cancer recommend active surveillance as an option for initial management of T1a 0- to 2-cm renal lesions, in addition to partial nephrectomy, radical nephrectomy, and focal ablation. However, contemporary data regarding the distribution of patient and renal cell carcinoma characteristics within this special patient group are scarce.
Within the SEER database (2002-2016), 13,364 patients with T1aNanyMany 0- to 2-cm renal lesions treated with nephrectomy were identified. Data were tabulated according to histologic subtype, Fuhrman grade (FG1-2 vs FG3-4), age category, and sex. In addition, rates of synchronous metastases were quantified.
Overall, clear-cell (69.3%), papillary (21.4%), chromophobe (6.9%), multilocular cystic (2.0%), sarcomatoid dedifferentiation (0.2%), and collecting-duct histologic subtypes (0.2%) were identified. Advanced age was associated with a lower rate of FG1-2 clear cell histologic subtype (70.8%-50.3%) but higher rates of FG1-2 papillary (11.1%-23.9%) and chromophobe histologic subtypes (6.2%-8.5%). Overall, 14.5% individuals harbored FG3-4 clear cell (9.8%) or FG3-4 papillary histologic subtypes (4.8%), and both were more prevalent in men. FG3-4 clear-cell and FG3-4 papillary histologic subtypes increased with age, more so in women than in men. The overall rate of synchronous metastases was 0.4% and ranged from 0 in the multilocular cystic subtype to 0.9% in the FG3-4 papillary histologic subtype, respectively, except for 13.8% in the sarcomatoid dedifferentiation histologic subtype.
Most T1a 0- to 2-cm renal cell carcinoma represents the low-grade clear-cell or low-grade papillary histologic subtype, with an FG3-4 minority. Even in patients with the FG3-4 histologic subtype, rates of synchronous metastases are virtually zero.
NCCN 肿瘤学临床实践指南建议，对于 T1a0-2cm 肾病变，除部分肾切除术、根治性肾切除术和局灶性消融外，还可以选择主动监测作为初始治疗选择。然而，目前关于该特殊患者群体中患者和肾细胞癌特征分布的当代数据很少。
在 SEER 数据库（2002-2016 年）中，确定了 13364 例接受肾切除术治疗的 T1aNanyMany0-2cm 肾病变患者。根据组织学亚型、Fuhrman 分级（FG1-2 与 FG3-4）、年龄类别和性别对数据进行了制表。此外，还量化了同步转移的发生率。
总体而言，识别出透明细胞（69.3%）、乳头状（21.4%）、嫌色细胞（6.9%）、多房囊性（2.0%）、肉瘤样去分化（0.2%）和集合管组织学亚型（0.2%）。高龄与 FG1-2 透明细胞组织学亚型（70.8%-50.3%）的低发生率相关，但 FG1-2 乳头状（11.1%-23.9%）和嫌色细胞组织学亚型（6.2%-8.5%）的高发生率相关。总体而言，14.5%的个体存在 FG3-4 透明细胞（9.8%）或 FG3-4 乳头状组织学亚型（4.8%），两者在男性中更为常见。FG3-4 透明细胞和 FG3-4 乳头状组织学亚型随年龄增长而增加，女性比男性更为明显。同步转移的总体发生率为 0.4%，范围从多房囊性亚型的 0 到 FG3-4 乳头状组织学亚型的 0.9%，肉瘤样去分化组织学亚型除外，为 13.8%。
大多数 T1a0-2cm 肾细胞癌代表低级别透明细胞或低级别乳头状组织学亚型，FG3-4 亚型较少。即使在 FG3-4 组织学亚型的患者中，同步转移的发生率也几乎为零。
