Department of Urology, University Hospital Olomouc Palacký University Olomouc, Olomouc, Czech Republic.
Olomouc University Social Health Institute, Palacky University Olomouc, Olomouc, Czech Republic.
BMC Urol. 2024 Aug 22;24(1):175. doi: 10.1186/s12894-024-01543-3.
Partial nephrectomy (PN) has become the dominant treatment modality for cT1 renal tumor lesions. Tumors suspected of malignant potential are indicated for surgery, but some are histologically classified as benign lesions after surgery. This study aims to analyze the number of benign findings after PN according to definitive histology and to evaluate whether there is an association between malignant tumor findings and individual factors.
The retrospective study included 555 patients who underwent open or robotic-assisted PN for a tumor in our clinic from January 2013 to December 2020. The cohort was divided into groups according to definitive tumor histology (malignant tumors vs. benign lesions). The association of factors (age, sex, tumor size, R.E.N.A.L.) with the malignant potential of the tumor was further evaluated.
In total, 462 tumors were malignant (83%) and 93 benign (17%). Of the malignant tumors, 66% were clear-cell RCC (renal cell carcinoma), 12% papillary RCC, and 6% chromophobe RCC. The most common benign tumor was oncocytoma in 10% of patients, angiomyolipoma in 2%, and papillary adenoma in 1%. In univariate analysis, there was a higher risk of malignant tumor in males (OR 2.13, 95% CI 1.36-3.36, p = 0.001), a higher risk of malignancy in tumors larger than 20 mm (OR 2.32, 95% CI 1.43-3.74, p < 0.001), and a higher risk of malignancy in tumors evaluated by R.E.N.A.L. as tumors of intermediate or high complexity (OR 2.8, 95% CI 1.76-4.47, p < 0.001). In contrast, there was no association between older age and the risk of malignant renal tumor (p = 0.878).
In this group, 17% of tumors had benign histology. Male sex, tumor size greater than 20 mm, and intermediate or high R.E.N.A.L. complexity were statistically significant predictors of malignant tumor findings.
部分肾切除术 (PN) 已成为治疗 cT1 肾肿瘤病变的主要治疗方式。怀疑有恶性潜能的肿瘤需要手术治疗，但有些肿瘤在手术后被组织学分类为良性病变。本研究旨在根据明确的组织学分析 PN 后良性发现的数量，并评估恶性肿瘤发现与个体因素之间是否存在关联。
这项回顾性研究纳入了 2013 年 1 月至 2020 年 12 月在我院接受开放或机器人辅助 PN 治疗的 555 例患者。该队列根据明确的肿瘤组织学（恶性肿瘤与良性病变）进行分组。进一步评估了因素（年龄、性别、肿瘤大小、R.E.N.A.L.）与肿瘤恶性潜能的关系。
共有 462 个肿瘤为恶性（83%），93 个为良性（17%）。恶性肿瘤中，透明细胞肾细胞癌（RCC）占 66%，乳头状 RCC 占 12%，嫌色细胞 RCC 占 6%。最常见的良性肿瘤是 10%的患者为嗜酸细胞瘤，2%为血管平滑肌脂肪瘤，1%为乳头状腺瘤。在单因素分析中，男性患恶性肿瘤的风险更高（OR 2.13，95%CI 1.36-3.36，p=0.001），肿瘤大于 20mm 时恶性肿瘤的风险更高（OR 2.32，95%CI 1.43-3.74，p<0.001），肿瘤评估为 R.E.N.A.L. 时为中级或高级复杂程度的肿瘤恶性肿瘤的风险更高（OR 2.8，95%CI 1.76-4.47，p<0.001）。相比之下，年龄较大与患恶性肾肿瘤的风险无关（p=0.878）。
在本研究中，17%的肿瘤为良性组织学。男性、肿瘤大小大于 20mm 以及中等或高 R.E.N.A.L. 复杂性是恶性肿瘤发现的统计学显著预测因子。
