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1.
Bani-Hani AH Leibovich BC Lohse CM Cheville JC Zincke H Blute ML 《The Journal of urology》2005,173(2):391-394
PURPOSE: We determined the incidence of and factors associated with the development of renal cell carcinoma (RCC) in the contralateral kidney after nephrectomy for localized RCC. MATERIALS AND METHODS: Between 1970 and 2000, 2,352 patients with sporadic, localized unilateral RCC and a normal contralateral kidney underwent nephrectomy for RCC. Cancer specific survival rates were estimated using the Kaplan-Meier method. Univariate Cox proportional hazards models were used to determine associations with outcome. RESULTS: Of the 2,352 patients studied 28 (1.2%) had RCC in the contralateral kidney, including 20 with clear cell and 8 with papillary RCC. Mean time from primary surgery to contralateral recurrence was 5.2 years (median 4.8, range 0 to 18) for clear cell RCC compared with 5.6 years (median 1.3, range 0 to 21) for papillary cell RCC. Positive surgical margins (risk ratio 14.23, p = 0.010) and multifocality (risk ratio 5.74, p = 0.019) were significantly associated with contralateral recurrence following nephrectomy for clear cell RCC, while nuclear grade (risk ratio for grades 3/4 vs 1/2, 4.78, p = 0.040) was significantly associated with contralateral recurrence following nephrectomy for papillary RCC. In patients with clear cell RCC estimated cancer specific survival rates 1, 3, and 5 years following contralateral recurrence were 93.8%, 80.2% and 72.9%, respectively. CONCLUSIONS: In patients with localized RCC and a normal contralateral kidney who underwent nephrectomy for RCC positive surgical margins and multifocality were significant predictors of contralateral recurrence for clear cell RCC, while nuclear grade was a significant predictor of contralateral recurrence for papillary RCC. 相似文献
2.
Cyst-associated renal cell carcinoma: Clinicopathologic characteristics and evaluation of prognosis in 27 cases 总被引:5,自引:0,他引:5
Tetsuro Onishi Yukihiko Oishi Hirokazu Goto Masayuki Tomita Kazuhiro Abe Shingo Sugaya 《International journal of urology》2001,8(6):268-274
BACKGROUND: No consistent clinicopathologic characteristics of cyst-associated renal cell carcinoma (CRCC) have previously been determined. METHODS: In total, 768 patients with renal cell carcinoma (RCC) underwent radical or partial nephrectomy. Renal cell carcinoma was classified as CRCC in 27 of these patients (3.5%, subdivided into RCC originating in a cyst and cystic RCC), clear-cell RCC in 662 patients (86.2%), chromophobe cell renal carcinoma in 36 patients (4.7%) and papillary RCC in 43 patients (5.6%) according to the criteria of the World Health Organization. RESULTS: The pathologic stage and nuclear grade were usually lower in those with CRCC (low stage/low grade; 89%/96%) or chromophobe cell renal carcinoma (low stage/low grade; 89%/80%) than in those with clear-cell RCC (low stage/low grade; 59%/65%) or papillary RCC (low stage/low grade; 53%/69%). Of the 27 CRCC patients, only 19 (70%) could be diagnosed through preoperative imaging studies. Patients with CRCC showed a favorable prognosis (survival rate: 95% at 1 year, 89.7% at 3 years and 84.4% thereafter) and, especially among the patients with RCC originating in a cyst, no cancer-related death was observed. Comparing the survival among four types of RCC, a favorable outcome was observed in cases of CRCC or chromophobe cell renal carcinoma compared with clear-cell RCC or papillary RCC (clear vs chromophobe: P = 0.002; chromophobe vs papillary: P = 0.019; clear vs cyst-associated: P = 0.001; papillary vs cyst-associated: P = 0.00079). CONCLUSIONS: In cases of CRCC, the disease was usually detected at lower stages and grades and therefore the prognosis was better than in cases of other types of RCC. Preoperative diagnosis of this disease was very difficult, especially in cases of RCC originating in a cyst. 相似文献
3.
Brian Douglas Facundo Davaro Allison May Sameer Siddiqui Zachary Hamilton 《Urologic oncology》2021,39(7):438.e23-438.e30
BackgroundRenal cell carcinoma (RCC) most commonly afflicts older patients while those 40 years old or younger represent an uncommon population. We aim to describe the tumor characteristics and treatment patterns for young kidney cancer patients utilizing the National Cancer Database.MethodsThe National Cancer Database Participant User File for RCC was queried from 2004 to 2016. Demographics and treatment trends were analyzed and compared between a young cohort, those aged 40 and younger vs. a conventional cohort, those older than 40. Pathology analyzed included clear cell, papillary, chromophobe, RCC not otherwise specified, and miscellaneous uncategorized. Subanalysis was performed for patients with localized disease and treatment type.ResultsAmongst the 514,879 patients diagnosed with RCC, 4.7% were ≤40 years old. RCC for individuals ≤40 has a higher proportion of female gender, non-Caucasian race, and chromophobe pathology, relative to the conventional cohort. Younger patients more often presented with cT1 disease with decreased rates of metastasis. Risk of 30-day readmission after surgery was similar between cohorts. For patients with cT1-2N0M0 disease, there was a decreasing rate of radical nephrectomy and increasing rate of partial nephrectomy; however, the conventional cohort had an increasing rate of percutaneous ablation while this remained stable in the younger cohort.ConclusionYoung RCC patients had a higher proportion of female gender, chromophobe histology, and favorable tumor characteristics. Partial nephrectomy has seen a dramatic increase in application regardless of age while percutaneous ablation increased only in the conventional cohort. 相似文献
4.
目的 探讨青年和中老年肾脏恶性肿瘤患者临床病理特点. 方法 回顾性分析1986-2007年收治的83例青年(≤40岁)与703例中老年(>40岁)肾脏恶性肿瘤患者的临床及病理资料. 结果 青年女性患者首发症状中腹痛(12/27,44.4%)和肿块(2/27,7.4%)发生率显著高于中老年组(154/703,21.9%和154/703,1.3%),均P<0.05.青年组透明细胞癌(47/83,56.6%)发生率低于中老年组(501/703,71.3%),P<0.05,以青年男性(31/56,55.4%)显著.青年组乳头状肾癌(21/83,25.3%)发生率较中老年组患者(118/703,16.8%)有升高趋势(P=0.054),其中青年男性(17/56,30.4%)显著(P=0.011);与中老年组患者(12/703,1.7%)相比,青年组其他类型肿瘤(包括恶性纤维组织细胞瘤、平滑肌肉瘤等)所占比例(6/83,7.2%)明显增高(P<0.05),以青年女性(4/27,14.8%)显著;青年男性组肿瘤≤4 cm比例明显高于中老年组(24/56,42.9%与173/703,24.6%);>7 cm比例(12/56,21.4%)则低于中老年组(295/703,42.0%),均P<0.05.青年组5年生存率为91.6%(76/83),中老年组为80.9%(669/709),2组比较差异有统计学意义(P<0.05).结论 与中老年组肾脏恶性肿瘤患者相比,青年组患者总体预后较好.青年女性患者临床表现典型,预后较差;而青年男性乳头状肾癌、小肾癌比例较高,预后较好.提示应加强对青年人群特别是对青年女性的肾肿瘤普查. 相似文献
5.
Effect of papillary and chromophobe cell type on disease-free survival after nephrectomy for renal cell carcinoma 总被引:4,自引:0,他引:4
Beck SD Patel MI Snyder ME Kattan MW Motzer RJ Reuter VE Russo P 《Annals of surgical oncology》2004,11(1):71-77
Background The clinical staging of renal cortical tumors traditionally has not evaluated the potential effect of histological subtypes
on survival. Evidence suggests that conventional clear cell renal cell carcinoma (RCC) and nonconventional clear cell RCC
(chromophobe and papillary) have different metastatic potential. Using a large renal tumor database, we examined the effect
of tumor histology on the pattern of metastasis and patient survival.
Methods All patients with nonmetastatic renal cortical tumors undergoing partial or radical nephrectomy were identified from a renal
tumor database between July 1989 and July 2002. Kaplan-Meier and Cox regression tests were used for statistical analysis.
Results Analysis revealed 1057 patients: 794 with conventional clear cell RCC, 157 with papillary RCC, and 106 with chromophobe RCC.
Metastasis occurred in 95 conventional clear cell RCC, 9 papillary RCC, and 6 chromophobe RCC. Metastasis occurred in 95 conventional
clear cell RCC, 9 papillary RCC, and 6 chromophobe RCC with a median follow-up of 34.6, 43.0, and 33.2 months, respectively.
Using log-rank analysis, chromophobe and papillary RCC were associated with an improved disease-free survival at 5 years (P=.009 and .015, respectively). Multivariate analysis revealed tumor size, stage, and chromophobe histology as significant
variables for disease progression.
Conclusions Renal cortical tumors have distinct histological subtypes with varying degrees of metastatic potential. Conventional clear
cell RCC, which comprises two thirds of renal cortical tumors presenting with localized disease, has a less favorable outcome
when compared with papillary and chromophobe RCC. Controlling for size and stage, chromophobe, and not papillary, RCC was
a significant variable for disease progression compared with conventional clear cell RCC. Knowledge of renal cortical tumor
histological subtype is critical for projecting prognosis, tailoring follow-up strategies, and designing clinical trials.
Presented at the 56th Annual Cancer Symposium, Society of Surgical Oncology, San Diego, CA, March 5–9, 2003. 相似文献
6.
Leibovich BC Cheville JC Lohse CM Zincke H Frank I Kwon ED Merchan JR Blute ML 《The Journal of urology》2005,174(5):1759-1763
PURPOSE: We developed a clinically useful scoring algorithm to predict cancer specific survival for patients with clear cell metastatic renal cell carcinoma (RCC). MATERIALS AND METHODS: We studied 727 patients treated with radical nephrectomy for clear cell RCC from 1970 to 2000 who had distant metastases at nephrectomy (285) or in whom metastases subsequently developed (442). A scoring algorithm to predict cancer specific survival was developed using the regression coefficients from a Cox proportional hazards model. RESULTS: There were 606 deaths from clear cell RCC at a median of 1.0 years (range 0 to 14) following metastatic RCC. Constitutional symptoms at nephrectomy (+2), metastases to the bone (+2) or liver (+4), metastases in multiple simultaneous sites (+2), metastases at nephrectomy (+1) or within 2 years of nephrectomy (+3), complete resection of all metastatic sites (-5), tumor thrombus level I to IV (+3), and the primary pathological features of nuclear grade 4 (+3) and histological tumor necrosis (+2) were significantly associated with death from RCC. All patients started with a score of 0 and points were added or subtracted as indicated in parentheses. Cancer specific survival rates at 1 year were 85.1%, 72.1%, 58.8%, 39.0%, and 25.1%, respectively, for patients with scores of -5 to -1, scores of 0 to 2, scores of 3 to 6, scores of 7 or 8, and scores of 9 or more. CONCLUSIONS: This scoring algorithm can be used to predict cancer specific survival for patients with metastatic clear cell RCC. 相似文献
7.
Oleksandr N. Kryvenko 《Urologic oncology》2017,35(6):453-454
Objective
To determine characteristics of the peritumoral pseudocapsule (PC) between renal tumor subtypes.Methods
The peritumoral PCs of 160 pT1 renal tumors were examined, including 60 clear cell renal cell carcinomas (RCCs), 50 papillary RCCs, 25 chromophobe RCCs, and 25 oncocytoma. Pathologic features (presence or absence of PC, mean thickness, continuity, and invasion by tumor) were analyzed. PC thickness was measured using an ocular micrometer to the nearest 1/10 mm.Results
A complete PC was found in 77% of clear cell tumors, 74% of papillary, 28% of chromophobe, and 4% of oncocytomas. Tumor PC was present but incomplete in 18% of clear cell, 18% of papillary, 44% of chromophobe, and 56% of oncocytoma. The PC was entirely absent in no clear cell tumors, 6% of papillary, 28% of chromophobe, and 40% of oncocytoma. Mean PC thickness and presence of invasion beyond the PC differed significantly by tumor subtype. Clear cell RCC possessed the thickest PC showing invasion through the capsule in 8% of tumors compared to 30% of papillary tumors. Complete PC invasion was not seen in chromophobe RCC or renal oncocytoma. Oncocytoma and chromophobe RCC characteristically exhibited an incomplete or absent PC.Conclusions
The characteristics of peritumoral PC vary predictably with histologic subtype of renal neoplasms. Clear cell RCC shows the most consistent PC, with a lower rate of invasion beyond it compared to papillary RCC. Chromophobe and oncocytoma characteristically have an incomplete or absent PC. 相似文献8.
Renal cell and transitional cell carcinoma in a Japanese population undergoing maintenance dialysis 总被引:3,自引:0,他引:3
Satoh S Tsuchiya N Habuchi T Ishiyama T Seimo K Kato T 《The Journal of urology》2005,174(5):1749-1753
PURPOSE: We verified differences in the incidence, clinical characteristics and outcomes between patients on chronic dialysis for end stage renal disease with renal cell carcinoma (RCC) and those with transitional cell carcinoma (TCC). MATERIALS AND METHODS: Data regarding RCC and TCC were reviewed in the medical records of 6,201 patients with end stage renal disease who underwent chronic dialysis between January 1990 and June 2003 in our 38 affiliated dialysis centers, and data were compared with those reported in Australia and New Zealand. RESULTS: Among the patients RCC developed in 38 (0.61%) and TCC developed in 16 (0.26%) during maintenance dialysis. The primary renal disease was chronic glomerulonephritis in patients with RCC (68.4%) and diabetic nephropathy in patients with TCC (43.8%, p = 0.002). Mean patient age at initiation of dialysis was 45 years for those with RCC and 63 for those with TCC (p < 0.001). Mean interval from dialysis induction to tumor diagnosis was 143 months for patients with RCC and 54 months for patients with TCC (p < 0.001). Of 38 RCCs 23 (60.5%) were incidentally detected by regular abdominal imaging examinations while painless gross hematuria was the cardinal symptom in 13 (81.2%) of 16 TCCs. Overall and cancer specific survivals after tumor diagnosis were significantly superior in patients with RCC compared to those with TCC (p = 0.0001 and p = 0.0003, respectively), and the cancer specific 5-year survival was 88.9% for RCC and 29.5% for TCC. In both cancers tumor stage significantly increased the risk of cancer specific death. Compared with patients from Australia and New Zealand, the incidence of RCC was higher and that of TCC was lower in our patients (p <0.001). CONCLUSIONS: In the Japanese population on dialysis RCC is more common than TCC. Since long-term dialysis is a risk factor for RCC, regular imaging examinations may have contributed to the favorable outcome of our patients on dialysis with RCC. In contrast, the unfavorable outcome of TCC suggests the need for effective diagnostic measures for early detection of TCC in patients on dialysis. 相似文献
9.
Comparisons of outcome and prognostic features among histologic subtypes of renal cell carcinoma 总被引:20,自引:0,他引:20
Cheville JC Lohse CM Zincke H Weaver AL Blute ML 《The American journal of surgical pathology》2003,27(5):612-624
Our objective was to compare cancer-specific survival and to examine associations with outcome among the histologic subtypes of renal cell carcinoma (RCC). We studied 2385 patients whose first surgery between 1970 and 2000 was a radical nephrectomy for sporadic, unilateral RCC. All RCC tumors were classified following the 1997 Union Internationale Contre le Cancer and American Joint Committee on Cancer guidelines. There were 1985 (83.2%) patients with clear cell, 270 (11.3%) with papillary, 102 (4.3%) with chromophobe, 6 (0.3%) with collecting duct, 5 (0.3%) with purely sarcomatoid RCC and no underlying histologic subtype, and 17 (0.7%) with RCC, not otherwise specified. Cancer-specific survival rates at 5 years for patients with clear cell, papillary, and chromophobe RCC were 68.9%, 87.4%, and 86.7%, respectively. Patients with clear cell RCC had a poorer prognosis compared with patients with papillary and chromophobe RCC (p <0.001). This difference in outcome was observed even after stratifying by 1997 tumor stage and nuclear grade. There was no significant difference in cancer-specific survival between patients with papillary and chromophobe RCC (p = 0.918). The 1997 TNM stage, tumor size, presence of a sarcomatoid component, and nuclear grade were significantly associated with death from clear cell, papillary, and chromophobe RCC. Histologic tumor necrosis was significantly associated with death from clear cell and chromophobe RCC, but not with death from papillary RCC. Our results demonstrate that there are significant differences in outcome and associations with outcome for the different histologic subtypes of RCC, highlighting the need for accurate subtyping. 相似文献
10.
Verhoest G Veillard D Guillé F De La Taille A Salomon L Abbou CC Valéri A Lechevallier E Descotes JL Lang H Jacqmin D Tostain J Cindolo L Ficarra V Artibani W Schips L Zigeuner R Mulders PF Mejean A Patard JJ 《European urology》2007,51(5):1298-304; discussion 1304-5
OBJECTIVES: To analyse the influence of age at diagnosis on tumour characteristics and cancer-specific survival in renal cell carcinoma (RCC). METHODS: Data on age, tumour characteristics, and survival for 4774 patients from 12 European RCC databases were recorded. Patients were divided into four groups according to age at diagnosis: < or =40, >40 and <60, > or =60 and <80, and > or =80 yr. The following variables were analysed: TNM stage, Fuhrman grade, tumour size, symptoms at diagnosis, ECOG performance status (PS), and cancer-specific survival. The groups were compared for usual clinical and pathologic variables, and cancer-specific survival. RESULTS: The four groups accounted for 288 (6%), 1839 (38.5%), 2499 (52.3%), and 148 cases (3.2%), respectively. Differences were found among groups for tumour stage, symptoms at diagnosis, ECOG PS, Fuhrman grade (p<0.001), tumour size, M stage, and histologic subtype (p: 0.02). Patients < or =40 yr were more likely to have papillary or chromophobe RCCs and less likely to have clear-cell RCCs. No significant difference was found among groups for N stage (p: 0.15). The 5-yr cancer-specific survival rates for the four age categories were 85%, 74%, 70%, and 69%, respectively. In multivariate analysis age category remained an independent prognostic parameter (p<0.001). CONCLUSIONS: Renal tumours diagnosed in younger age are characterized by lower tumour stages and grades as well as favourable histologic patterns compared with tumours in older patients. Basic research is required for explaining such a relationship between age, tumour aggressiveness, and therefore tumour biology. 相似文献
11.
Thompson RH Leibovich BC Cheville JC Webster WS Lohse CM Kwon ED Zincke H Blute ML 《The Journal of urology》2006,176(3):900-3; discussion 903-4
PURPOSE: Renal cell carcinoma has been linked to numerous secondary malignancies. We evaluated the risk of secondary malignancies by renal cell carcinoma histological subtype in patients with clear cell, papillary and chromophobe renal cell carcinoma. MATERIALS AND METHODS: We studied 2,722 patients who underwent nephrectomy for sporadic renal cell carcinoma at our institution between 1970 and 2000. All specimens were reviewed by a single urological pathologist for histological subtype. Associations of second primary malignancies by histological subtype were evaluated using the chi-square and Fisher exact tests. RESULTS: Of the patients studied 2,188 (80.4%) had clear cell, 378 (13.9%) had papillary and 128 (4.7%) had chromophobe renal cell carcinoma. Patients with papillary renal cell carcinoma were significantly more likely to have colon cancer (p = 0.041), prostate cancer (p = 0.003), any second malignancy (p <0.001) and multiple malignancies (p <0.001) compared with patients with clear cell renal cell carcinoma. In addition, patients with chromophobe renal cell carcinoma were significantly more likely to have colon cancer than patients with clear cell renal cell carcinoma (p = 0.020). Although patients with papillary renal cell carcinoma were more likely to have bladder cancer, the incidence did not differ significantly compared with that in patients harboring clear cell and chromophobe renal cell carcinoma (p = 0.193). We did not find a significant difference in the incidence of breast cancer, lung cancer, rectal cancer or lymphoma among histological subtypes. CONCLUSIONS: Our data indicate that patients with papillary renal cell carcinoma are more likely to harbor secondary malignancies, including colon and prostate cancer, than patients with clear cell renal cell carcinoma. These results may have important implications for patient education and followup evaluation, and they should prompt mechanistic investigations. 相似文献
12.
Cystic renal cell carcinoma: biology and clinical behavior 总被引:9,自引:0,他引:9
Han KR Janzen NK McWhorter VC Kim HL Pantuck AJ Zisman A Figlin RA Dorey FJ Said JW Belldegrun AS 《Urologic oncology》2004,22(5):410-414
The purpose of the study was to evaluate unilocular and multilocular cystic renal cell carcinoma (cRCC). These tumors are a rare entity, comprising approximately 1 to 2% of all renal tumors, and their true biologic behavior is not well-known. Initial review of renal cell carcinoma (RCC) cases treated at our institution between 1989 and 2001 identified 39 cases of cRCC. However, histopathologic review of these cases by 2 pathologists revealed that only 18 cases met the criteria that all tumors have a cystic component that constitutes at least 75% of the total lesion without evidence of necrosis. These cases were compared to 614 conventional clear cell RCC cases with regards to clinical outcomes. All 18 patients presented with localized (N0M0) disease. Thirteen (72%) of the tumors were Fuhrman Grade 1, while the remaining 5 (28%) were Fuhrman Grade 2. By comparison, only 60% of the clear cell RCC tumors were Grade 1 or 2. Similarly, 83% of cRCC were pT1 tumors compared to only 35% of conventional clear cell tumors. Mean tumor size for the cRCC tumors was 4.9 cm compared to 7.4 cm for conventional clear cell tumors. Cystic RCC patients had an 82% four-year disease-specific survival (DSS). Unilocular and multilocular cRCC is a distinct subtype of clear cell RCC. Its biology appears to be more favorable with regards to important prognostic factors such as metastatic presentation, Fuhrman grade, 1997 T stage, and tumor size. These findings suggest that cRCC patients may benefit from nephron sparing surgery. 相似文献
13.
Taccoen X Valeri A Descotes JL Morin V Stindel E Doucet L Joulin V Bocqueraz F Coulange C Rambeaud JJ Fournier G Mejean A;Oncology Committee of the Association Française d'Urologie 《European urology》2007,51(4):980-987
OBJECTIVES: Renal cell carcinoma (RCC) is uncommon in young adults. Based on the few studies published to date, it is difficult to determine whether this tumour has a particular progression pattern. This retrospective, multicentre study analysed RCC in young patients, defined as =40 yr old, compared to RCC in older patients. METHODS: Between 1988 and 2000, 1233 patients, 93 under 40 yr old and 1140 older (mean ages, 34.2 and 61.9 years, respectively) underwent surgery for RCC in four teaching hospitals. Clinical and biologic parameters at diagnosis were compared and subjected to univariate and multivariate analyses to study survival. Mean follow-up was 4.5 yr for young and 4.1 yr for older patients. RESULTS: When comparing younger to older patients, respectively, they had a lower male-to-female ratio (1.2 vs. 2.5), lower stage (84.9% vs. 67.4% pT1-pT2N0M0; p=0.001), and fewer clear-cell carcinomas (73.1% vs. 82%), but more papillary carcinomas (20.4% vs. 11.4%; p=0.01) and better 5-yr cancer-specific survival rates (90.8% vs. 78.3%; p=0.005). Independent prognostic factors for survival, in the order of decreasing impact, were tumor stage (p<0.0001), Fuhrman nuclear grade (p<0.0001), and age =40 yr at diagnosis (risk ratio 0.4, p<0.047). Young patients tended to have a better 5-yr progression-free survival (80.5% vs. 70.7%; p=0.05). CONCLUSIONS: RCC in young adults was more often localised at diagnosis and had a better prognosis than the disease in older subjects. Age under 40 yr old was an independent prognostic factor for survival. 相似文献
14.
Siemer S Hack M Lehmann J Becker F Stöckle M 《The Journal of urology》2006,175(4):1240-3; discussion 1243-4
PURPOSE: Sporadic RCC is rare in young adults. We retrospectively reviewed the outcomes of patients 20 to 40 years old at our institution. MATERIALS AND METHODS: Between 1975 and 2004, 2,710 patients were treated surgically for renal masses at our institution. We found 120 patients (4.4%) 20 to 40 years old. We analyzed the clinical presentation, pathological characteristics and outcome of these patients, and compared it to patients older than 40 years. RESULTS: The mean age of 120 young adults was 34.1 years (range 20.4 to 39.8). Symptomatic presentation was documented in 49.5% of patients. RCC was found in 87 (72.5%) young adults. Young patients generally had a higher rate of organ confined tumors than patients older than 40 years (73.6% vs 59.3%, p <0.05). Histopathological characteristics, tumor size, lymph node metastases and distant metastatic disease did not differ significantly in young and older patients. Women were significantly more likely to have benign lesions (41% vs 20%, p <0.05). Mean followup for 120 patients was 80.6 months and 15 of 87 patients with RCC (17.2%) died of tumor related causes (mean followup 27.5 months). The 10-year cancer specific survival rate was 78% in young adults and 68% in older patients (p = 0.22). Multivariate Cox regression analysis revealed lymph node metastases and tumor differentiation grade as independent prognostic parameters in young patients. CONCLUSIONS: Young patients are more likely to have symptomatic tumors at presentation. Nevertheless, they have more favorable pathological features and a definite trend to superior disease specific survival following surgical treatment. Organ sparing surgery should be considered in young women since benign lesions are frequent found in this population. 相似文献
15.
Eggener SE Rubenstein JN Smith ND Nadler RB Kontak J Flanigan RC Waters WB Picken M Campbell SC Rubenstein JR 《The Journal of urology》2004,171(1):106-110
PURPOSE: The clinical and pathological features of solid or complex cystic renal masses in young adults have not been defined. We present our experience with patients 17 to 45 years old with such renal masses to define the incidence of malignant vs benign lesions, familial tendencies and clinical outcomes. MATERIALS AND METHODS: The medical records of all patients 17 to 45 years old who presented with a solid or suspicious complex cystic renal mass at 2 tertiary care hospitals between 1988 and 2002 were retrospectively reviewed. Pertinent clinical information was compiled, including age, gender, mode of presentation, renal function, year and type of surgery, pathological analysis and survival data. RESULTS: There were 114 evaluable patients who underwent a total of 119 nephrectomies. Mean patient age was 37.1 years and males comprised 56.1% of the population. Twelve patients had familial renal cell carcinoma (RCC), the von Hippel-Lindau syndrome. Mode of presentation for patients with sporadic disease was symptomatic (55.9%), incidental (35.3%) or unknown (8.8%). Radical nephrectomy, partial nephrectomy and nephroureterectomy were performed in 80 kidneys (67.2%), 37 (31.1%) and 2 (1.7%), respectively. Malignant lesions comprised 79.8% of all masses and 95.8% of these were renal cell carcinoma. Of the RCCs 75.8% were grade 1 or 2 and 89% were organ confined. Young women were much more likely than men to have a benign lesion (36.0% vs 9.5%, p <0.01) and the diversity of histologies was impressive (of the 24 total benign masses 9 were different tumor types). With an average followup of 38.3 months overall survival is 90.2%. Among patients with RCC 84.9% are alive and cancer-free, 11.6% are dead from disease and 3.5% are alive with recurrent disease. CONCLUSIONS: We report the largest known series of solid or suspicious complex renal masses in young adults. As expected, familial tumors are more common in this population. While RCC is the most common tumor, a wide variety of potential pathological outcomes are possible, particularly in women, who were much more likely to have a benign lesion. RCC in this patient population appears to have a favorable prognosis, despite symptomatic presentation in the majority of cases. 相似文献
16.
目的:探讨肾癌术后病理组织分型对预后的影响。方法:回顾性分析华西医院2002年7月至2014年6月行手术治疗的1 346例肾癌患者的临床病理资料,男839例,女507例;术时年龄(55.1±13.4)岁;美国东部肿瘤协作组(ECOG)评分0分911例,≥1分435例;透明细胞癌1 120例,乳头状细胞癌62例,嫌色细胞... 相似文献
17.
KIT and RCC are useful in distinguishing chromophobe renal cell carcinoma from the granular variant of clear cell renal cell carcinoma 总被引:3,自引:0,他引:3
The distinction between chromophobe renal cell carcinoma, the granular cell variant of clear cell renal cell carcinoma, and renal oncocytoma is a common diagnostic dilemma. The usefulness of KIT, CD10, RCC, and RON in the differential diagnosis of these renal epithelial tumors was investigated. KIT was 100% positive in chromophobe renal cell carcinoma (11 of 11) and renal oncocytoma (12 of 12). The KIT staining pattern was identical in both tumor types, with cytoplasmic membrane attenuation, and fine granular cytoplasmic staining. In contrast, KIT was absent in all granular cell variants of clear cell renal cell carcinoma (0 of 6). RCC was observed in more than 80% of the granular cell variant of clear cell renal cell carcinoma (5 of 6) but was negative in all chromophobe renal cell carcinomas (0 of 11) and renal oncocytomas (0 of 12). CD10 was expressed in 100% of the granular cell variant of clear cell renal cell carcinoma (6 of 6), 72% of chromophobe renal cell carcinomas (8 of 11), and 58% of renal oncocytomas (7 of 12). RON was 100% positive in the chromophobe renal cell carcinomas (11 of 11) and renal oncocytomas (12 of 12) but only 50% positive in the granular cell variant of clear cell renal cell carcinoma (3 of 6). Colloidal iron was diffusely and strongly positive in more than 80% of the chromophobe renal cell carcinomas (9 of 11), focally and weakly positive in 41% of the renal oncocytomas (5 of 12) but negative in all granular cell variant of clear cell renal cell carcinoma (0 of 6). The above results demonstrate that: 1) KIT is a very sensitive marker for both chromophobe renal cell carcinoma and renal oncocytoma; 2) immunohistochemistry using antibodies to KIT combined with RCC was sufficient to discriminate between chromophobe renal cell carcinoma and the granular cell variant of clear cell renal cell carcinoma; and 3) neither RON, nor KIT, nor a combination of this panel can be used to distinguish chromophobe renal cell carcinoma from renal oncocytoma. Colloidal iron staining aided in this distinction for the majority of the chromophobe renal cell carcinomas (more than 80% positive) and renal oncocytomas (close to 60% negative). 相似文献
18.
Sarcomatoid renal cell carcinoma: an examination of underlying histologic subtype and an analysis of associations with patient outcome 总被引:5,自引:0,他引:5
Cheville JC Lohse CM Zincke H Weaver AL Leibovich BC Frank I Blute ML 《The American journal of surgical pathology》2004,28(4):435-441
A sarcomatoid component can occur in all histologic subtypes of renal cell carcinoma (RCC) and indicates an aggressive tumor. We studied 2381 patients treated with radical nephrectomy for RCC between 1970 and 2000. A urologic pathologist reviewed the microscopic slides from all tumor specimens for the presence of a sarcomatoid component, defined as a RCC with any malignant spindle cell component. All tumors with a sarcomatoid component were classified as nuclear grade 4. A total of 120 (5.0%) patients had RCC with a sarcomatoid component, including 94 who died of RCC at a mean of 1.4 years following nephrectomy (median 8 months; range 44 days to 10 years). Cancer-specific survival rates at 2 and 5 years following nephrectomy were 33.3% and 14.5%, respectively. The presence of distant metastases at the radical nephrectomy and histologic tumor necrosis were significantly associated with death from RCC among patients with sarcomatoid RCC. Patients with clear cell (conventional) RCC and chromophobe RCC were more likely to have tumors with a sarcomatoid component (5.2% and 8.7%, respectively) compared with patients with papillary RCC (1.9%). The presence of a sarcomatoid component was significantly associated with death from RCC for all three subtypes (P < 0.001). Even among patients with grade 4 clear cell RCC, the presence of a sarcomatoid component was significantly associated with outcome, both univariately (risk ratio 1.59; P = 0.010) and after adjusting for TNM stage, tumor size, and histologic tumor necrosis (risk ratio 1.46; P = 0.037). 相似文献
19.
OBJECTIVE: To study the incidence, clinical presentation, pathological prognostic factors and disease outcome of RCC in young adults less than 40-years-old. MATERIAL AND METHODS: The notes of 400 patients treated by radical nephrectomy for RCC suspicion, between January 1984 and december 1999 were reviewed. Twenty-nine patients (7.25%) were under 40. RESULTS: The most common histological cell type was clear cell carcinoma, found in 20 patients (69%). At a median follow-up of 80 months, 20 patients (69%) were disease free and 9 (31%) died of the disease. When comparing patients less than 40 years vs older than 40 years, we found significant differences in histology type (clear cell carcinoma 69% vs 91%; P = 0.0001), and tumor stage at presentation (pT2 = 34.5% vs 17.3%; P = 0.04) (pT3 = 20.7% vs. 42%; P = 0.03). Disease free survival was not significantly different between the 2 groups (69% vs 65.7%; Log rank test P = 0.4). CONCLUSION: Although rare, RCC in young adults seems to follow a course similar to the disease seen in older patients. Stage at presentation was different between the 2 populations however survival was not affected by age. 相似文献
20.
《Urologic oncology》2015,33(12):505.e9-505.e13
IntroductionCystic renal cell carcinoma (cystic RCC) is thought to carry an improved prognosis relative to clear cell RCC (CCRCC); however, this is based on small case series. We used a population-based tumor registry to compare clinicopathologic features and cancer-specific mortality (CSM) of cystic RCC with those of CCRCC.Materials and methodsThe Surveillance, Epidemiology, and End Results database was queried for all patients diagnosed and treated for cystic RCC and CCRCC between 2001 and 2010. Clinical and pathologic factors were compared using t tests and chi-square tests as appropriate. Kaplan-Meier survival analysis compared CSM differences between cystic RCC and CCRCC.ResultsA total of 678 patients with cystic RCC and 46,677 with CCRCC were identified. The mean follow-up duration was 52 and 40 months, respectively. When compared with CCRCC patients, those with cystic RCC were younger (mean age 58 vs. 61 y, P <0.001), more commonly black (22% vs. 9%, P<0.001), and female (45% vs. 41%, P = 0.02). Cystic RCCs were more commonly T1a tumors (66% vs. 55%, P<0.001), well differentiated (33% vs. 16%, P<0.001), and smaller (mean size = 3.8 vs. 4.5 cm, P<0.001). Cystic RCC was associated with a reduction in CSM when compared with CCRCC (P = 0.002). In a subset analysis, this reduction in CSM was seen only for those with T1b/T2 tumors (P = 0.01) but not for those with T1a RCCs lesions (P = 0.31).ConclusionsWe report the largest series of cystic RCC and corroborate the findings of improved CSM when compared with CCRCC for larger tumors; however, no difference was noted in smaller tumors, suggesting that tumor biology becomes more relevant to prognosis with increasing size. These data may suggest a role for active surveillance in appropriately selected patients with small, cystic renal masses. 相似文献