Wunderlich H, Reichelt O, Schumann S, Schlichter A, Kosmehl H, Werner W, Vollandt R, Schubert J
Department of Urology, Institute of Pathology, Friedrich-Schiller-University, Jena, Germany.
J Urol. 1998 May;159(5):1465-9. doi: 10.1097/00005392-199805000-00012.
Although radical nephrectomy is the standard treatment for localized unilateral renal cell carcinoma with a normal contralateral kidney, there is ongoing interest in the use of nephron sparing surgery or partial nephrectomy in such cases. The extent of radical surgery in such cases has also been reconsidered in view of the uncertainty regarding the malignant or benign nature.
Of 14,793 autopsies in Jena from 1985 until 1995 there were 260 renal cell carcinomas. Of the 260 renal cell carcinomas the diameter was 40 mm. or less in 104. These 104 tumors were divided into group 1-20 mm. or less (33 cases), group 2-21 to 30 mm. (28) and group 3-31 to 40 mm. (43).
Grade 1 renal cell carcinomas decreased in frequency with increasing tumor diameter, while an opposite result was noted for grade 3. Lymph node and distant metastases were well correlated with tumor size. With an increase in tumor size the frequency of venous involvement increased as well. Significantly more multifocal malignant renal cell carcinomas were seen in tumors between 21 and 40 mm. compared to those 20 mm. or less in diameter.
The metastatic potential and biology of these small nodules are not yet known. To lower the risk of local recurrence the results of our study suggest that nephron sparing surgery might be advisable in patients with renal cell carcinoma 20 mm. or less in diameter.
尽管根治性肾切除术是对侧肾脏正常的局限性单侧肾细胞癌的标准治疗方法，但对于在此类病例中使用保留肾单位手术或部分肾切除术仍存在持续的兴趣。鉴于恶性或良性性质的不确定性，此类病例中根治性手术的范围也已重新考虑。
1985年至1995年在耶拿进行的14793例尸检中，有260例肾细胞癌。在这260例肾细胞癌中，直径为40毫米或更小的有104例。这104个肿瘤被分为1组 - 20毫米或更小（33例），2组 - 21至30毫米（28例）和3组 - 31至40毫米（43例）。
1级肾细胞癌的频率随肿瘤直径增加而降低，而3级则出现相反结果。淋巴结和远处转移与肿瘤大小密切相关。随着肿瘤大小的增加，静脉受累的频率也增加。与直径20毫米或更小的肿瘤相比，在21至40毫米的肿瘤中发现多灶性恶性肾细胞癌的情况明显更多。
这些小结节的转移潜能和生物学特性尚不清楚。为降低局部复发风险，我们的研究结果表明，对于直径20毫米或更小的肾细胞癌患者，保留肾单位手术可能是可取的。
