Serendipitous renal cell carcinoma in the post-CT era: continued evidence in improved outcomes
Serendipitous renal cell carcinoma in the post-CT era: continued evidence in improved outcomes
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DOI：
10.1016/s1078-1439(02)00205-3
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发表时间：
2003-01-01
影响因子：
2.7
通讯作者：
Thompson, IM
中科院分区：
文献类型：
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作者：
Leslie, JA;Prihoda, T;Thompson, IM
目的：在CT扫描和超声检查更加频繁的时代，比较意外和非意外发现的肾细胞癌(RCCA)的患者和肿瘤特征，包括生存数据。材料和方法：回顾德克萨斯州圣安东尼奥奥迪·L·墨菲退伍军人医院肿瘤登记处1985年1月至1999年12月的RCCA新诊断或初步治疗。对于RCCA的初始诊断是否是偶然的，对记录进行评估。收集预后和流行病学变量，并计算特定疾病和总生存率的数据。结果：257例RCCA患者中，93例(36.2%)为偶然发现的肿瘤，100例为转移瘤。与病理(6.74cmvs.4.49 cm，P<；0.0001)和放射学测量(8.04cmvs.4.87 cm，P<；0.0001)相比，偶发组的平均肿瘤体积更小。在93个偶然发现的肿瘤中，66个(71%)被诊断为I期肿瘤，而在163个非偶然发现的肿瘤中，只有30个(18.4%)被诊断为I期(P<；0.0001)。排除非偶发肿瘤初发时有转移的患者，I期患者的比例低于偶发肿瘤(46.8%vs.71%，P=0.004)。病理证实的肿瘤分期更有利于偶然发现的肿瘤：77例非偶然肿瘤中40例(60%)为PT3，86例偶然肿瘤中70例(81.4%)为PT3(P<；0.0001)。偶然事件组的总体和疾病特定存活率也较好，5年疾病特定事件存活率为94%，而非偶然事件组为35%(P<；0.0001)。结论：CT扫描和超声检查的广泛应用导致相当数量的RCCA的偶然诊断继续增加，这些RCCA的诊断阶段明显较低，从而显著提高了存活率。(C)2003 Elsevier Science Inc.保留所有权利。
Purpose: To compare patient and tumor characteristics, including survival data, between serendipitous and non-serendipitously discovered renal cell carcinoma (RCCA) in an era of more frequent use of CT scanning and ultrasonography. Materials and methods: The Tumor Registry of the Audie L. Murphy VA Hospital in San Antonio, TX, was reviewed for new diagnoses or initial treatment of RCCA from January 1985 through December 1999. Records were evaluated as to whether the initial diagnosis of RCCA was made serendipitously. Prognostic and epidemiological variables, were collected and disease-specific and overall survival,data were computed. Results: Of 257 patients with RCCA, 93 (36.2%) presented with serendipitously discovered tumors and 100 presented with metastases at diagnosis. Mean tumor size was smaller in the serendipitous group, compared both pathologically (6.74 cm vs. 4.49 cm, P < 0.0001) and by radiographic measurement (8.04 cm vs. 4.87 cm, P < 0.0001). Sixty-six (71%) of 93 serendipitously discovered tumors were Stage I at diagnosis, vs. only 30 (18.4%) of 163 non-serendipitous tumors (P < 0.0001). When non-serendipitous tumors with metastatic disease at presentation were excluded, the percentage of patients with Stage I disease was lower than for serendipitous tumors (46.8% vs. 71%, P = 0.004). Pathologically confirmed tumor stage was more favorable for serendipitously discovered tumors: 40 of 77 (60%) non-serendipitous tumors were < pT3, vs. 70 of 86 (81.4%) serendipitous tumors (P < 0.0001). Overall and disease-specific survival was better in the serendipitous group as well, with a 5-year disease-specific survival of 94%, contrasted with 35% in the non-serendipitous group (P < 0.0001). Conclusions: The widespread use of CT scanning and ultrasonography has led to a continued increase in the serendipitous diagnosis of a significant number of all RCCA which are associated with significantly lower stage at diagnosis, and thus with significantly improved survival. (C) 2003 Elsevier Science Inc. All rights reserved.