A Multi-institutional Study on Histopathological Characteristics of Surgically Treated Renal Tumors: the Importance of Tumor Size
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Purpose: The incidence of accidentally detected small renal tumors is increasing throughout the world. In this multi- institutional study performed in Korea, histopathological characteristics of contemporarily surgically removed renal tumors were reviewed with emphasis on tumor size. Materials and Methods: Between January 1995 and May 2005, 1,702 patients with a mean age of 55 years underwent surgical treatment at 14 training hospitals in Korea for radiologically suspected malignant renal tumors. Clinicopathological factors and patient survival were analyzed. Results: Of the 1,702 tumors, 91.7% were malignant and 8.3% were benign. The percentage of benign tumors was significantly greater among those ≤4cm (13.2%) than those >4cm (4.5%) (p<0.001). Among renal cell carcinoma patients, the percentage of tumors classed as stage ≥T3 was significantly less among tumors ≤4cm (5.2%) than those >4cm (26.8%) (p<0.001). The percentage of tumors classed as Fuhrman's nuclear grades ≥ 3 was also significantly less among tumors ≤4cm (27.3%) than tumors >4cm (50.9%) (p<0.001). The 5-year cancer- specific survival rate was 82.7%, and T stage (p<0.001), N stage (p<0.001), M stage (p=0.025), and Fuhrman's nuclear (p< 0.001) grade were the only independent predictors of cancer-specific survival. Conclusion: In renal tumors, small tumor size is prognostic for favorable postsurgical histopathologies such as benign tumors, low T stages, and low Fuhrman's nuclear grades. Our observations are expected to facilitate urologists to adopt function-preserving approach in the planning of surgery for small renal tumors with favorable predicted outcomes.
Abstract
Purpose: The incidence of accidentally detected small renal tumors is increasing throughout the world. In this multi- institutional study performed in Korea, histopathological characteristics of contemporarily surgically removed renal tumors were reviewed with emphasis on tumor size. Materials and Methods: Between January 1995 and May 2005, 1,702 patients with a mean age of 55 years underwent surgical treatment at 14 training hospitals in Korea for radiologically suspected malignant renal tumors. Clinicopathological factors and patient survival were analyzed. Results: Of the 1,702 tumors, 91.7% were malignant and 8.3% were benign. The percentage of benign tumors was significantly greater among those ≤4cm (13.2%) than those >4cm (4.5%) (p<0.001). Among renal cell carcinoma patients, the percentage of tumors classed as stage ≥T3 was significantly less among tumors ≤4cm (5.2%) than those >4cm (26.8%) (p<0.001). The percentage of tumors classed as Fuhrman's nuclear grades ≥ 3 was also significantly less among tumors ≤4cm (27.3%) than tumors >4cm (50.9%) (p<0.001). The 5-year cancer- specific survival rate was 82.7%, and T stage (p<0.001), N stage (p<0.001), M stage (p=0.025), and Fuhrman's nuclear (p< 0.001) grade were the only independent predictors of cancer-specific survival. Conclusion: In renal tumors, small tumor size is prognostic for favorable postsurgical histopathologies such as benign tumors, low T stages, and low Fuhrman's nuclear grades. Our observations are expected to facilitate urologists to adopt function-preserving approach in the planning of surgery for small renal tumors with favorable predicted outcomes.
참고문헌 (20)
- Jayson M, "Increased incidence of serendipitously discovered renal cell carcinoma", Urology, 51, pp.203~205 (1998)
- Patard JJ, "The changing evolution of renal tumours: a single center experience over a two-decade period", Eur Urol, 45, pp.490~494 (2004)
- Luciani LG, "Incidental renal cell carcinoma-age and stage characterization and clinical implications: study of 1092 patients (1982-1997)", Urology, 56, pp.58~62 (2000)
- Duchene DA, "Histopathology of surgically managed renal tumors: analysis of a contemporary series", Urology, 62, pp.827~830 (2003)
- Lee CT, "Surgical management of renal tumors 4 cm. or less in a contemporary cohort", J Urol, 163, pp.730~736 (2000)
- Lam JS, "Changing concepts in the surgical management of renal cell carcinoma", Eur Urol, 45, pp.692~705 (2004)
- Marszalek M, "Elective open nephron-sparing surgery for renal masses: single-center experience with 129 consecutive patients", Urology, 64, pp.38~42 (2004)
- Dechet CB, "Prospective analysis of intraoperative frozen needle biopsy of solid renal masses in adults", J Urol, 162, pp.1282~1284 (1999)
- Guinan P, "TNM staging of renal cell carcinoma: Workgroup No. 3. Union International Contre le Cancer (UICC) and the American Joint Committee on Cancer (AJCC)", Cancer, 80, pp.992~993 (1997)
- Skinner DG, "Diagnosis and management of renal cell carcinoma. A clinical and pathologic study of 309 cases", Cancer, 28, pp.1165~1177 (1971)
- Valeri A, "Pathological features of kidney masses 4 cm or less: the less frequently malignant nature compared to larger tumours, supports the interest of nephron sparing surgery (abstract)", Eur Urol Suppl, 4, pp.49~ (2005)
- Lieber MM, "Renal oncocytoma", Urol Clin North Am, 20, pp.355~359 (1993)
- Yen TH, "Renal oncocytoma in Taiwan", Ren Fail, 28, pp.141~147 (2006)
- Jeschke K, "Laparoscopic nephron-sparing surgery for renal tumors", Urology, 58, pp.688~692 (2001)
- Snyder ME, "Incidence of benign lesions for clinically localized renal masses smaller than 7 cm in radiological diameter: influence of sex", J Urol, 176, pp.2391~2395 (2006)
- Lemaitre L, "Imaging of angiomyolipomas", Semin Ultrasound CT MR, 18, pp.100~114 (1997)
- Milner J, "Fat poor renal angiomyolipoma: patient, computerized tomography and histological findings", J Urol, 176, pp.905~909 (2006)
- Dechet CB, "Prospective analysis of computerized tomography and needle biopsy with permanent sectioning to determine the nature of solid renal masses in adults", J Urol, 169, pp.71~74 (2003)
- Rybicki FJ, "ES, Fielding JR, vanSonnenberg E, Silverman SG. Percutaneous biopsy of renal masses: sensitivity and negative predictive value stratified by clinical setting and size of masses", AJR Am J Roentgenol, 180, pp.1281~1287 (2003)
- Kim H, "Genitourinary Pathology Study Group of the Korean Society of Pathologists. Renal cell carcinoma in South Korea: a multicenter study", Hum Pathol, 35, pp.1556~1563 (2004)