Morphologic typing of papillary renal cell carcinoma: Comparison of growth kinetics and patient survival in 66 cases
Morphologic typing of papillary renal cell carcinoma: Comparison of growth kinetics and patient survival in 66 cases
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DOI：
10.1053/hupa.2001.24984
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发表时间：
2001-06-01
期刊：
影响因子：
3.3
通讯作者：
Bilous, AM
中科院分区：
文献类型：
--
作者：
Delahunt, B;Eble, JN;Bilous, AM
鉴于乳头状肾细胞癌现在被确定为肾细胞瘤形成的一个亚型，这些肿瘤分为2个不同的形态类型已被提出。I型肿瘤的细胞在乳头状核心的基底膜上排列成单层，细胞质稀少，呈淡黄色。在这些肿瘤中，经常可见沙粒体和泡沫状巨噬细胞，并且肿瘤经常表达细胞角蛋白7。2型肿瘤细胞具有假复层细胞核，通常具有大量嗜酸性细胞质。最近的研究支持乳头状肾细胞癌的这种亚分类，证明1型和2型肿瘤的不同基因型。为了进一步研究乳头状肾细胞癌的亚型，我们比较了50例1型和16例2型乳头状肾细胞癌的临床特征、核分级、分期、肿瘤生长动力学和生存率。患者就诊时的年龄、性别和原发肿瘤大小的比较显示，两种肿瘤类型之间无显著差异。与2型肿瘤相比，1型肿瘤的Fuhrman分级显著降低（P = .0001），Robson分期显著升高（P = .009）。当肿瘤根据TNM分期时，没有显著差异。肿瘤生长动力学评估显示，平均银染核仁组成区（AgNOR）评分和Ki-67指数存在显著差异（AgNOR 1型，3.83，2型，7.24，P = .0001; Ki 67 I型，3.17%，2型，6.01%，P = .0002）。多变量分析显示肿瘤类型（P = 0.03）、转移（P = 0.04）、AgNOR评分（P = 0.001）和Ki-67指数（P = 0.03）与生存率独立相关。这些结果提供了根据组织学特征将乳头状肾细胞癌分为两型的临床实用性证据。Copyright（C）2001 by W.B.桑德斯公司
Whereas papillary renal cell carcinoma is now established as a subtype of renal cell neoplasia, division of these tumors into 2 distinctive morphotypes has been proposed. Type I tumors have cells with scanty pale cytoplasm arranged in a single layer on the basement membrane of papillary cores. In these tumors, psammoma bodies and foamy macrophages are frequently seen, and the tumors frequently express cytokeratin 7. Type 2 tumor cells have pseudostratified nuclei and usually have voluminous eosinophilic cytoplasm. Recent studies have supported this subclassification of papillary renal cell carcinoma by demonstrating differing genotypes for type 1 and 2 tumors. To further study the subclassification of papillary renal carcinoma, we compared clinical features, nuclear grade, stage, tumor growth kinetics, and survival in a series of 50 type 1 and 16 type 2 papillary renal cell carcinomas. Comparison of patient age at presentation, sex, and primary tumor size shows no significant difference between the 2 tumor types. Type 1 tumors were of significantly lower Fuhrman grade (P = .0001) and higher Robson stage (P = .009) than type 2 tumors. There was no significant difference when tumors were staged according to the TNM classification. Assessment of tumor growth kinetics showed significantly different mean silver-staining nucleolar organizer region (AgNOR) scores and Ki-67 indices (AgNOR type 1, 3.83, type 2, 7.24, P = .0001; Ki 67 type I, 3.17%, type 2, 6.01%, P = .0002). Multivariate analysis showed tumor type (P = .03), presence of metastases (P = .04), AgNOR score (P = .001), and Ki-67 index (P = .03) to be independently associated with survival. These results provide evidence of the clinical utility of dividing papillary renal cell carcinomas into 2 types according to histologic characteristics. Copyright (C) 2001 by W.B. Saunders Company.