Growth pattern of renal cell carcinoma (RCC) in patients with delayed surgical intervention
Growth pattern of renal cell carcinoma (RCC) in patients with delayed surgical intervention
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DOI：
10.1007/s00432-011-1083-0
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发表时间：
2012-02-01
影响因子：
3.6
通讯作者：
He, Zhi-Song
中科院分区：
文献类型：
--
作者：
Li, Xue-Song;Yao, Lin;He, Zhi-Song
目的：很少有研究评价延迟治疗的肾细胞癌（RCC）患者的生长模式。本报告调查的增长率和阶段进展意外发现RCC后，一个长期的积极surveillance.Methods 32例患者没有接受立即手术治疗肾实质性肿块，后来被证明是RCC进行了回顾性分析。根据CT或MRI上最大直径的变化计算肿瘤的年生长率。结果经46.0个月的中位观察期，肿瘤中位直径从2.14（0.30-6.70）cm增长到4.33（1.40-8.80）cm。平均肿瘤生长速率为0.80（范围，0.16-3.80）cm/年。透明细胞癌（0.86 cm/年）比乳头状细胞癌（0.28 cm/年）生长更快（P = 0.066）。2级肿瘤的平均生长速度（0.88 cm/年）快于1级肿瘤（0.36 cm/年）（P = 0.041）。13例肿瘤（40.6%）在初次就诊后中位48个月时分期升高。考克斯回归分析显示，初始肿瘤大小是唯一的风险因素，为upstaging（P = 0.018）。在我们的队列中没有局部和全身复发的干预后，在中位数为47（范围，6-248）months的follow-up.Conclusions肾癌被发现是缓慢增长的一组未经治疗的肾细胞癌患者。然而，一些肿瘤在观察阶段进展。肾细胞癌的生长速度与组织学分级和组织学亚型有关。
Purpose Few studies have evaluated the growth pattern of renal cell carcinoma (RCC) in patients with delayed treatment. This report investigated the growth rate and stage progression of incidentally discovered RCC following a long period of active surveillance.Methods Thirty-two patients who did not receive immediate surgical treatment for renal solid masses that later proved to be RCC were reviewed retrospectively. Annual tumor growth rates were calculated according to changes in the maximal diameter on CT or MRI. Clinical and pathological characteristics associated with tumor growth rate and stage progression were analyzed.Results The median tumor size grow from 2.14 (range, 0.30-6.70) cm to 4.33 (range, 1.40-8.80) cm after a median 46.0 months observation period. The average tumor growth rate was 0.80 (range, 0.16-3.80) cm/year. Clear cell carcinoma (0.86 cm/year) tended to grow faster than papillary cell carcinoma (0.28 cm/year) (P = 0.066). The mean growth rate of grade 2 tumors (0.88 cm/year) was faster than that of grade 1 tumors (0.36 cm/year) (P = 0.041). Thirteen tumors (40.6%) were upstaged at a median 48 months after initial presentation. Cox regression analysis revealed initial tumor size as the only risk factor for upstaging (P = 0.018). No local and systemic recurrences were noted in our cohort after the intervention at a median of 47 (range, 6-248) months of follow-up.Conclusions RCCs were found to be slow growing in a group of untreated renal cell carcinoma patients. However, some tumors progressed in stage under observation. The growth rate of RCC tended to correlate with histologic grade and histologic subtype.