The Probability of Aggressive Versus Indolent Histology Based on Renal Tumor Size: Implications for Surveillance and Treatment
The Probability of Aggressive Versus Indolent Histology Based on Renal Tumor Size: Implications for Surveillance and Treatment
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DOI：
10.1016/j.eururo.2018.06.003
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发表时间：
2018-10-01
期刊：
影响因子：
23.4
通讯作者：
Leibovich, Bradley C.
中科院分区：
文献类型：
--
作者：
Bhindi, Bimal;Thompson, R. Houston;Leibovich, Bradley C.
背景：虽然已经描述了基于肾肿瘤大小的恶性和良性组织学的概率，但这本身并不足以为现代的决策提供信息，因为惰性恶性肿瘤可以通过积极的监测来管理。目的：基于放射学肿瘤大小来表征侵袭性和惰性组织学的可能性。设计、背景和参与者：我们评估了1990至2010年间在梅奥诊所接受根治性或部分肾切除术的患者的PT1-2、PNX/0、M0实体肾肿瘤。病理检查由一位泌尿生殖病理学家进行。高度透明细胞癌、高度乳头状肾细胞癌、集合管肾细胞癌、移位相关性肾细胞癌、遗传性肌瘤病肾细胞癌、未分类肾细胞癌和恶性非肾细胞癌均为侵袭性肿瘤，以及任何凝固性坏死(低度乳头状肾细胞癌除外)或肉瘤样分化的肿瘤。其余的良性肿瘤和恶性肿瘤被认为是惰性的。结果测量和统计分析：使用Kaplan-Meier方法估计癌症特异性生存(CSS)。根据肿瘤大小，使用Logistic回归模型估计恶性和侵袭性组织学的概率。结果和限制：在纳入的2650名患者中，1860名患者患有惰性肿瘤(300名良性患者，1560名恶性患者)，790名患者患有侵袭性肿瘤。10年CSS对惰性恶性肿瘤为96%，对侵袭性恶性肿瘤为81%。任何恶性组织学和侵袭性组织学的预测百分比随着肿瘤大小的增加而增加。具体地说，2厘米、3厘米和4厘米肿瘤的恶性可能性估计分别为84%、87%和88%，侵袭性组织学的可能性分别为18%、24%和29%。对于任何给定的肿瘤大小，男性比女性有更大的侵袭性组织学机会。这一观察性手术队列的潜在局限性包括选择偏差。结论：我们提出了基于肿瘤大小的肾肿块侵袭性组织学可能性的估计。这些信息应该对最初的患者咨询和管理有用。患者摘要：主动监测是肾脏肿块的一种选择，即使它们是恶性的。除了知道肿块是良性肿瘤还是癌症之外，了解它是否是侵袭性肿瘤也很重要。这项研究提供了肿瘤大小和性别的特定估计，以评估有肾肿块的患者的总体癌症和侵袭性癌症的概率，以帮助最初的决策。(C)2018年，由爱思唯尔公司代表欧洲泌尿学协会出版。
Background: While the probability of malignant versus benign histology based on renal tumor size has been described, this alone does not sufficiently inform decision-making in the modern era since indolent malignant tumors can be managed with active surveillance.Objective: To characterize the probability of aggressive versus indolent histology based on radiographic tumor size.Design, setting, and participants: We evaluated patients who underwent radical or partial nephrectomy at Mayo Clinic for a pT1-2, pNx/0, M0 solid renal tumor between 1990 and 2010. Pathology was reviewed by one genitourinary pathologist. High-grade clear-cell renal cell carcinoma (RCC), high-grade papillary RCC, collecting duct RCC, translocation-associated RCC, hereditary leiomyomatosis RCC, unclassified RCC, and malignant non-RCC tumors were all considered aggressive, as well as any tumors demonstrating coagulative necrosis (except low-grade papillary RCC) or sarcomatoid differentiation. The remaining benign and malignant tumors were considered indolent.Outcome measurements and statistical analysis: Cancer-specific survival (CSS) was estimated using the Kaplan-Meier method. Logistic regression models were used to estimate the probability of malignant and aggressive histology based on tumor size. Sex-stratified analyses were also performed.Results and limitations: Of the 2650 patients included, there were 1860 patients with indolent tumors (300 benign; 1560 malignant) and 790 with aggressive tumors. The 10-yr CSS was 96% for indolent malignant tumors and 81% for aggressive malignant tumors. The predicted percentages of any malignant histology as well as aggressive histology increased with tumor size. Specifically, 2 cm, 3 cm, and 4 cm tumors have an estimated 84%, 87%, and 88% likelihood of malignancy, respectively, and an 18%, 24%, and 29% likelihood of aggressive histology, respectively. For any given tumor size, men had a greater chance of aggressive histology than women. Potential limitations of this observational surgical cohort include selection bias.Conclusions: We present tumor size-based estimates of the probability of aggressive histology for renal masses. This information should be useful for initial patient counseling and management.Patient summary: Active surveillance is an option for kidney masses, even if they are malignant. Beyond knowing whether the mass is benign or cancer, it is important to know whether or not it is an aggressive tumor. This study presents tumor size-specific and sex-specific estimates of the probability of cancer overall and aggressive cancer among patients with a kidney mass in order to aid with initial decision-making. (C) 2018 Published by Elsevier B.V. on behalf of European Association of Urology.