T_(1a)期肾恶性肿瘤大小与预后不良病理特征的相关性研究

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英文篇名：Correlation between tumor size and adverse histopathologic characteristics in patients with clinical T_(1a) renal cell carcinoma 作者：陈宇锋 ; 朱梁松 ; 王建丰 ; 孔文 ; 陈勇辉 ; 黄翼然 ; 薛蔚 ; 张进 英文作者：CHEN Yufeng;ZHU Liangsong;WANG Jianfeng;KONG Wen;CHEN Yonghui;HUANG Yiran;XUE Wei;ZHANG Jin;Department of Urology,Renji Hospital,Shanghai Jiao Tong University School of Medicine;Department of Urology,Putuo Hospital of Shanghai University of Traditional Chinese Medicine; 关键词：肾肿瘤 ; 大小 ; 不良病理特征 英文关键词：renal tumor;;tumor size;;adverse histopathologic characteristic 中文刊名：LCMW 英文刊名：Journal of Clinical Urology 机构：上海交通大学医学院附属仁济医院泌尿科;上海中医药大学附属普陀医院泌尿外科; 出版日期：2019-07-03 12:11 出版单位：临床泌尿外科杂志 年：2019 期：v.34;No.307 语种：中文; 页：LCMW201907015 页数：4 CN：07 ISSN：42-1131/R 分类号：58-61

摘要

目的:探讨T_(1a)期肾肿瘤大小与预后不良病理特征的关系。方法:回顾性分析2009年1月～2016年12月上海交通大学医学院附属仁济医院泌尿科(东院)收治的1 703例肿瘤直径<4cm的T_(1a)期肾肿瘤且病理确诊为肾细胞癌患者,排除良性病变。分析不同肿瘤大小与一些不良病理特征之间的关系,包括组织类型Fuhrman高级别、伴淋巴管浸润、伴坏死、伴肉瘤样变、Ⅱ型乳头状癌及高分期(≥pT_3)等。结果:1 703例肾细胞癌患者中男1 201例(70.5%),女502例(29.5%),中位年龄56(20～89)岁,平均肿瘤最大直径(2.7±0.9)cm。各种不良病理特征共发生197例(11.6%),<1cm 1例,1～2cm 11例,>2～3cm 78例,>3～4cm 107例,进一步发现肿瘤的大小与组织类型Fuhrman高级别(P<0.001)、伴组织坏死(P<0.001)、Ⅱ型乳头状癌(P=0.049)及T分期≥pT_3期(P=0.018)等明显相关。肿瘤大小与各项危险因素的相关性分析得出Fuhrman级别(r=0.287,P<0.001)、是否伴有组织坏死(r=0.130,P<0.001)、病理分级是否>T_3期(r=0.090,P<0.001)、是否伴有肉瘤样变(r=0.052,P=0.032)和Ⅱ型乳头状癌百分比(r=0.051,P=0.035)均有统计学意义。结论:T_(1a)期肾癌的肿瘤大小亦与一些预示不良的病理特征有显著相关性,直径≤2cm肿瘤的各种不良病理特征发生率较少,直径>2cm肿瘤直径越大,不良病理特征的发生率亦显著增加,危险程度明显提高。
        Objective:To evaluate the relationship between the tumor size of the T_(1a)renal tumor and the incidence of adverse pathologic features.Method:We retrospectively analyzed 1703renal cell carcinoma patients with tumor size less than 4cm in Renji hospital from January 2009to December 2016,and excluded the benign lesion.The relationship between tumor size and the undesirable pathological characteristics,including the high Fuhrman degree,lymphovascular invasion,histologic tumor necrosis,sarcomatoid features,papillary typeⅡhistology and advanced stage(≥pT_3)was analyzed.Result:There were 1 703cases of renal cell carcinoma including 1 201(70.5%)males and 502(29.5%)females.Their median age was 56years old(range,20-89),and the average tumor diameter was(2.7±0.9)cm.The number of all kinds of bad pathologic feature was 197(11.6%),1in<1cm group,11in 1-2cm group,78in>2-3cm group,and 107in>3-4cm group.Further studies showed that tumor size was significantly related with the high Fuhrman degree(P<0.001),histologic tumor necrosis(P<0.001),papillary with typeⅡhistology(P=0.049)and advanced stage(P=0.018).Spearman analysis also showed that the tumor size was significantly associated with the incidence of adverse pathologic features,such as Fuhrman degree(r=0.287,P<0.001),histologic tumor necrosis(r=0.130,P<0.001),advanced stage(r=0.090,P<0.001),sarcomatoid features(r=0.052,P=0.032),papillary typeⅡhistology(r=0.051,P=0.035).Conclusion:T_(1a)renal tumor size was significantly associated with some aggressive pathological characteristics.When the tumor is smaller than 2cm,the incidence of adverse pathologic features is limited.Conversely,the incidence increases when the tumor is larger than 2cm,which predicts a relative aggressive results.

引文

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