Bretheau D, Lechevallier E, Eghazarian C, Grisoni V, Coulange C
Department of Urology, Salvator Hospital, Marseille, France.
Eur Urol. 1995;27(4):319-23. doi: 10.1159/000475189.
From 1980 to 1991, 236 patients with renal cell carcinoma were treated in our department. We studied the characteristics and the prognostic significance of 74 patients with incidental renal cancer in comparison with those with symptomatic tumors. The mean age of the patients was 59.8 years and the sex ratio 2 males/1 female. The incidence of incidental tumors increased from 14% in 1980 to 48% in 1991. Incidental tumors were discovered mainly during examination for cardiovascular diseases (26%), hepatobiliary diseases (22%) and general health examination (23%). Local tumoral stage and histologic grade were significantly lower for the incidental tumors than for symptomatic ones (p = 0.002 and p = 0.001). In the same way, the rates of the patients with metastases or nodal involvement were lower for those with incidental tumors than for those with symptomatic tumors (p = 0.008 and p = 0.001). The mean tumoral size was 5.7 +/- 3 cm for incidental tumors and 7.6 +/- 3.5 cm for symptomatic tumors (p = 0.0001). The survival was significantly different according to the circumstances of detection of the tumors (p < 0.001); the 5- and 10-year actuarial survival rates was 85% for the patients with incidental tumors and respectively 61 and 44% for the patients with symptomatic tumors. The multivariate analysis by Cox proportional hazard model showed three important and independent prognostic factors: the presence of metastases (relative risk (RR): 6.7), nodal involvement (RR: 4.6) and symptomatic tumors (RR: 1.7). The patients with incidental tumors had a better prognosis than those with symptomatic tumors because of lower tumoral size and local stage. The early diagnosis of renal cell carcinoma improved the prognosis of the patients.
1980年至1991年期间，我科共收治236例肾细胞癌患者。我们研究了74例偶然发现的肾癌患者的特征及其预后意义，并与有症状的肿瘤患者进行了比较。患者的平均年龄为59.8岁，男女比例为2∶1。偶然发现的肿瘤发生率从1980年的14%上升至1991年的48%。偶然发现的肿瘤主要在心血管疾病检查（26%）、肝胆疾病检查（22%）及全身健康检查（23%）过程中被发现。偶然发现的肿瘤的局部肿瘤分期和组织学分级显著低于有症状的肿瘤（p = 0.002和p = 0.001）。同样，偶然发现肿瘤的患者发生转移或淋巴结受累的比例低于有症状肿瘤的患者（p = 0.008和p = 0.001）。偶然发现的肿瘤的平均肿瘤大小为5.7±3 cm，有症状肿瘤的平均肿瘤大小为7.6±3.5 cm（p = 0.0001）。根据肿瘤的发现情况，患者的生存率有显著差异（p < 0.001）；偶然发现肿瘤的患者5年和10年精算生存率分别为85%，有症状肿瘤的患者5年和10年精算生存率分别为61%和44%。Cox比例风险模型的多因素分析显示，有三个重要且独立的预后因素：转移的存在（相对风险（RR）：6.7）、淋巴结受累（RR：4.6）和有症状的肿瘤（RR：1.7）。由于肿瘤大小和局部分期较低，偶然发现肿瘤的患者比有症状肿瘤的患者预后更好。肾细胞癌的早期诊断改善了患者的预后。
