International Agency for Research on Cancer, World Health Organization, 150 Cours Albert Thomas, 69372, Lyon Cedex 8, France.
Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
Virchows Arch. 2021 Jun;478(6):1099-1107. doi: 10.1007/s00428-020-02986-3. Epub 2021 Jan 5.
There are unexplained geographical variations in the incidence of kidney cancer with the high rates reported in Baltic countries, as well as eastern and central Europe. Having access to a large and well-annotated collection of "tumor/non-tumor" pairs of kidney cancer patients from the Czech Republic, Romania, Serbia, UK, and Russia, we aimed to analyze the morphology of non-neoplastic renal tissue in nephrectomy specimens. By applying digital pathology, we performed a microscopic examination of 1012 frozen non-neoplastic kidney tissues from patients with renal cell carcinoma. Four components of renal parenchyma were evaluated and scored for the intensity of interstitial inflammation and fibrosis, tubular atrophy, glomerulosclerosis, and arterial wall thickening, globally called chronic renal parenchymal changes. Moderate or severe changes were observed in 54 (5.3%) of patients with predominance of occurrence in Romania (OR = 2.67, CI 1.07-6.67) and Serbia (OR = 4.37, CI 1.20-15.96) in reference to those from Russia. Further adjustment for comorbidities, tumor characteristics, and stage did not change risk estimates. In multinomial regression model, relative probability of non-glomerular changes was 5.22 times higher for Romania and Serbia compared to Russia. Our findings show that the frequency of chronic renal parenchymal changes, with the predominance of chronic interstitial nephritis pattern, in kidney cancer patients varies by country, significantly more frequent in countries located in central and southeastern Europe where the incidence of kidney cancer has been reported to be moderate to high. The observed association between these pathological features and living in certain geographic areas requires a larger population-based study to confirm this association on a large scale.
在肾癌的发病率方面存在着无法解释的地理差异，波罗的海国家以及东欧和中欧地区的发病率较高。我们从捷克共和国、罗马尼亚、塞尔维亚、英国和俄罗斯的肾癌患者中获得了大量经过良好注释的“肿瘤/非肿瘤”配对样本，旨在分析肾切除标本中非肿瘤性肾组织的形态。通过应用数字病理学，我们对来自肾癌患者的 1012 份冷冻非肿瘤性肾组织进行了显微镜检查。评估并对 4 个肾实质成分的间质炎症和纤维化、肾小管萎缩、肾小球硬化和动脉壁增厚的强度进行评分，这些成分统称为慢性肾实质改变。在 54 名患者（5.3%）中观察到中度或重度变化，其中罗马尼亚（OR=2.67，CI 1.07-6.67）和塞尔维亚（OR=4.37，CI 1.20-15.96）的发生率明显高于俄罗斯。进一步调整合并症、肿瘤特征和分期并未改变风险估计。在多项回归模型中，罗马尼亚和塞尔维亚的非肾小球变化的相对概率是非俄罗斯的 5.22 倍。我们的研究结果表明，在肾癌患者中，慢性肾实质改变的频率因国家而异，其中以慢性间质性肾炎为主的改变在位于中欧和东南欧的国家中更为常见，这些国家的肾癌发病率被报告为中等至较高。这些病理特征与生活在特定地理区域之间的观察到的关联需要更大规模的基于人群的研究来大规模证实这种关联。
