Gutiérrez Baños J L, Martín García B, Hernández Rodríguez R, Portillo Martín J A, Correas Gómez M A, Dél Valle Schaan J I, Roca Edreira A, Vega Vega A, Villanueva Peña A
Servicio de Urología, Hospital Universitario Valdecilla Santander, Cantabria, España.
Arch Esp Urol. 1996 Jul-Aug;49(6):580-6.
To analyze the incidence of tumoral satellite nodules in renal carcinoma, study the main features of the primary tumor and establish an approach to determine the risk of multicentricity.
We analyzed 286 radical nephrectomies due to renal carcinoma. Twenty-nine cases (10.13%) that had intrarenal tumoral nodules were chosen; 5 cases (17.2%) had adenoma and 24(82.8%) had carcinoma. All but one case with von Hippel Lindau disease were sporadic tumors. The main features of the principal tumor (size, cellular type, architectural features, grade and stage) in both groups with and without nodules, were analyzed and compared.
The mean diameter was 7.89 +/- 4.091 cm (range 3.5-20) for the tumor and 0.85 +/- 0.65 cm (range 0.1-3) for the nodule. The mean tumor diameter was not significantly different from that of the group with no nodules (mean tumor diameter 8.16 +/- 3.58, range 2-25). Ten cases had only 1 nodule (34.48%), 4 had 2 (13.79%), 2 had 3 (6.89%), 3 had 4 (10.34%) and 10 had 5 or more nodules (34.48%). The mean age was 56.89 +/- 11.46 (range 22-76); 24 were males (82.75%) and 5 females (17.14%); 14 cases were located in the right (28.27%) and 15 in the left side (51.72%). The foregoing data were not significantly different from those of the group with no nodules. Nineteen cases had clear cell, 5 granular, 4 mixed and 1 had the fusiform cell type. Seventeen cases were grade 2 (68%) and 8 cases grade 3 (32%); there were no G1 or G4. Ten were Robson stage I (34.48%), 2 were stage II (6.89%), 11 stage III (37.93%) and 6 stage IV (20.68%). Three cases had local recurrence (10.34%). No differences were observed for survival between the two groups. A 3 cm nodule was diagnosed preoperatively in only one case. Assuming the following criteria of a localized tumor, stage I, with a diameter less than 5 cm for performing elective nephron-sparing surgery, only 8 of the 43 cases that met the foregoing criteria had nodules (16.18%). Of these, 4 (2 of which were adenomas) had a single nodule (9.3%). If the criterion of low grade (G1-G2) tumor is also considered, only 5 of the 27 cases that met the foregoing additional criterion had nodules (14.7%).
When nephron-sparing surgery is performed, it should be remembered that there is an approximately 10% risk of leaving tumor nodules of small size in the kidney which may cause local recurrence. Consequently, these patients should be followed very closely.
分析肾癌中肿瘤卫星结节的发生率，研究原发肿瘤的主要特征，并建立一种确定多中心性风险的方法。
我们分析了286例因肾癌而行根治性肾切除术的病例。选择了29例（10.13%）肾内有肿瘤结节的病例；其中5例（17.2%）为腺瘤，24例（82.8%）为癌。除1例患有冯·希佩尔-林道病外，其余均为散发性肿瘤。分析并比较了有结节组和无结节组主要肿瘤的主要特征（大小、细胞类型、结构特征、分级和分期）。
肿瘤的平均直径为7.89±4.091cm（范围3.5 - 20cm），结节的平均直径为0.85±0.65cm（范围0.1 - 3cm）。肿瘤的平均直径与无结节组无显著差异（肿瘤平均直径8.16±3.58cm，范围2 - 25cm）。10例仅有1个结节（34.48%），4例有2个结节（13.79%），2例有3个结节（6.89%），3例有4个结节（10.34%），10例有5个或更多结节（34.48%）。平均年龄为56.89±11.46岁（范围22 - 76岁）；男性24例（82.75%），女性5例（17.14%）；14例位于右侧（28.27%），15例位于左侧（51.72%）。上述数据与无结节组无显著差异。19例为透明细胞型，5例为颗粒细胞型，4例为混合型，1例为梭形细胞型。17例为2级（68%），8例为3级（32%）；无1级或4级。10例为罗布森I期（34.48%），2例为II期（6.89%），11例为III期（37.93%），6例为IV期（20.68%）。3例出现局部复发（10.34%）。两组之间的生存率无差异。术前仅1例诊断出3cm的结节。假设对于局限性肿瘤、I期、直径小于5cm的情况采用选择性保留肾单位手术的以下标准，在符合上述标准的43例病例中，仅有8例有结节（16.18%）。其中，4例（其中2例为腺瘤）有单个结节（9.3%）。如果再考虑低级别（G1 - G2）肿瘤的标准，在符合上述附加标准的27例病例中，仅有5例有结节（14.7%）。
在进行保留肾单位手术时，应记住肾内可能残留小的肿瘤结节，其导致局部复发的风险约为10%。因此，应对这些患者进行密切随访。
