Pecoraro Angela, Deuker Marina, Rosiello Giuseppe, Stolzenbach Franziska, Luzzago Stefano, Tian Zhe, Shariat Shahrokh F, Saad Fred, Briganti Alberto, Kapoor Anil, Fiori Cristian, Porpiglia Francesco, Karakiewicz Pierre I
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy.
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Department of Urology, University Hospital Frankfurt, Frankfurt, Germany.
Urol Oncol. 2021 Apr;39(4):239.e1-239.e7. doi: 10.1016/j.urolonc.2021.01.003. Epub 2021 Feb 16.
The NCCN guidelines recommend active surveillance (AS) as an option for the initial management of cT1a 0-2 cm renal lesions. However, data about comparison between renal cell carcinoma (RCC) 0-2 cm vs. 2.1-4 cm are scarce.
Within the Surveillance, Epidemiology, and End Results database (2002-2016), 46,630 T1a NM stage patients treated with nephrectomy were identified. Data were tabulated according to histological subtype, tumor grade (low [LG] vs. high [HG]), as well as age category and gender. Additionally, rates of synchronous metastases were quantified.
Overall, 69.3 vs. 74.1% clear cell, 21.4 vs. 17.6% papillary, 6.9 vs. 6.8% chromophobe, 2.0 vs. 1.1% sarcomatoid dedifferentiation, 0.2 vs. 0.2% collecting duct histological subtype were identified for respectively 0-2 cm and 2.1-4 cm RCCs. In both groups, advanced age was associated with higher rate of HG clear cell and HG papillary histological subtype. In 0-2 cm vs. 2.1-4 cm RCCs, 13.8% vs. 20.2% individuals operated on harbored HG tumors and were more prevalent in males. Lower synchronous metastases rates were recorded in 0-2 cm RCC and ranged from 0 in respectively multilocular cystic to 0.9% in HG papillary histological subtype. The highest synchronous metastases rates were recorded in sarcomatoid dedifferentiation histological subtype (13.8% and 9.7%) in both groups.
Relative to 2.1-4 cm RCCs, 0-2 cm RCCs harbored lower rates of HG tumors, lower rates of aggressive variant histology and lower rates of synchronous metastases. The indications and demographics of patients selected for AS may be expanded in the future to include younger and healthier patients.
美国国立综合癌症网络（NCCN）指南推荐主动监测（AS）作为cT1a期0 - 2 cm肾肿瘤初始治疗的一种选择。然而，关于0 - 2 cm与2.1 - 4 cm肾细胞癌（RCC）之间比较的数据很少。
在监测、流行病学和最终结果数据库（2002 - 2016年）中，确定了46630例接受肾切除术治疗的T1a期NM分期患者。数据根据组织学亚型、肿瘤分级（低级别[LG]与高级别[HG]）以及年龄类别和性别进行列表。此外，对同时性转移率进行了量化。
总体而言，0 - 2 cm和2.1 - 4 cm RCC分别确定的透明细胞比例为69.3%对74.1%，乳头状为21.4%对17.6%，嫌色细胞为6.9%对6.8%，肉瘤样去分化为2.0%对1.1%，集合管组织学亚型为0.2%对0.2%。在两组中，高龄与高级别透明细胞和高级别乳头状组织学亚型的发生率较高相关。在0 - 2 cm与2.1 - 4 cm RCC中，接受手术的患者中分别有13.8%和20.2%患有高级别肿瘤，且在男性中更为普遍。0 - 2 cm RCC的同时性转移率较低，在多房囊性肿瘤中分别为0，在高级别乳头状组织学亚型中为0.9%。两组中肉瘤样去分化组织学亚型的同时性转移率最高（分别为13.8%和9.7%）。
相对于2.1 - 4 cm RCC，0 - 2 cm RCC的高级别肿瘤发生率较低，侵袭性变异组织学发生率较低，同时性转移率较低。未来，选择进行主动监测的患者的适应证和人口统计学特征可能会扩大，以包括更年轻、更健康的患者。
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