良性占位性病变误诊为肾癌的原因分析

目的　提高肾脏良恶性占位的诊断水平 ,降低误诊率。　方法　肾占位性病变患者 12例 ,年龄 35～ 6 9岁 ,平均 5 2岁。腰部胀痛不适 9例 ,其中 2例伴全程血尿 ;体检超声偶然发现肾脏占位 3例。术前均行超声、CT等影像学检查诊断为肾癌。　结果　 12例患者均手术治疗。术中行冰冻病理检查 7例 ,提示为肾脏良性占位 ,行肿块剜除或单纯肾切除术 ;按肾癌行根治术 5例 ,术后病理均为肾脏良性病变。随访 1～ 3年 ,无复发。　结论　临床医师不应过高评价CT及超声等影像检查的诊断学意义 ,对无法确诊病例可行手术探查 ,术中行冰冻病理检查提高确诊率。多数误诊的良性肾占位与肾癌的影像学表现不同。     

非肾癌肾实质实性占位的诊疗(附58例病例报告)

目的 总结临床诊治非肾癌肾实质实性占位的经验,提高非肾癌肾实质实性占位的诊治水平.方法 回顾性分析经临床或病理诊断为非肾癌肾实质实性占位的58例患者的临床资料.结果 根据58例非肾癌肾实质实性占位患者的病例特点,予46例患者行手术治疗.手术效果确切.结论 非肾癌肾实质实性占位常规临床实验室检查和影像学检查术前常难以做出准确诊断,术中冰冻病理结果对诊断及具体手术方案的制定很有帮助.对于诊断为错构瘤和肾嗜酸性细胞瘤的患者,可适当放宽肾脏部分切除的手术适应证,尽量减少肾切除手术.     

肾脏偶发占位病变的诊治体会

目的提高小于３．０ｃｍ偶发性肾脏占位病变的诊治效果。方法对４９例肾脏偶发占位病变的诊治进行回顾性总结。结果Ｂ超检查发现３６例,ＣＴ检查发现１３例。肾癌３１例,高密度肾囊肿１０例,肾错构瘤７例,肾皮质腺瘤１例。肾癌术后死亡１例,生存超过５年者１４例,１例肾错构瘤随诊肿瘤增大０．６ｃｍ,余未见异常。结论肾脏偶发占位病变应根据Ｂ超、ＣＴ、ＭＲＩ综合分析作出诊断,定性不明者应行术中冰冻病检。     

肾脏良性占位病变的术前诊断(附37例报告)

目的 提高肾脏良性占位病变的术前诊断及鉴别诊断水平。方法 对１５年来收治３７例肾占位病变患者的临床资料与Ｂ超、ＣＴ、彩超之表进行分析总结。结果 肾脏良性占位病变占肾实性占位病变有提示诊断有意义。结论 随着Ｂ超、ＣＴ的普及,肾脏良性占位病变检出率呈上升趋势。Ｂ超、ＣＴ及彩超联合检查可绝大多数肾良性占位病变在术前作出诊断和提示,结合术前穿刺或术中冰冻活检可与肾癌相鉴别,避免不必要的根治性肾切除。     

囊性肾癌5例报告并文献复习

目的:探讨囊性肾癌的早期诊断及治疗方法。方法:回顾性分析2008年1月~2012年8月间收治的5例囊性肾癌患者的临床资料,1例术前影像学检查提示双侧肾脏占位病变,一侧为囊性占位病变;4例显示单侧肾脏单发囊性占位病变,左肾3例,右肾1例;其中男3例,女2例;年龄46~68岁,平均56.4岁;肿瘤体积21.84~208ml,平均101.96ml。按照Bosniak分类,Ⅱ类1例,Ⅲ类2例,Ⅳ类2例;T1期2例,T2期2例,T3期1例。3例术前诊断为囊性肾癌,1例为肾脏囊肿,1例为肾嗜酸性细胞瘤合并囊性肾癌。2例行肾癌根治术,2例行肾部分切除术,1例行囊肿去顶减压术后2周行肾癌根治术。并结合相关文献复习进行分析讨论。结果:5例患者术后病理检查报告证实为透明细胞癌2例,乳头状细胞癌1例,多房囊性肾癌1例,嗜酸细胞腺瘤伴囊性变1例。平均随访34.4个月(10~66个月),1例发生骨骼及肺部转移,余4例均无复发转移。结论:囊性肾癌是一种广义上的肾癌分类,有四种分型;与其他类型肾癌相比,大部分恶性程度较低。囊性肾癌的术前诊断主要依赖于影像学检查,对于可疑病例,术中需行快速冷冻病理检查。对此类肿瘤,建议行保留肾单位手术。     

45例肝脏少见良性实性占位性病变的临床诊治分析

目的探讨肝少见肝脏良性占位病变的临床特点,提高对肝脏少见良性占位性病变的认识及临床确诊率。方法回顾性分析45例肝脏少见良性占位性病变,结合患者的临床资料分析肝少见良性占位性病变治疗经验。结果 B超检查45例,腹部CT检查38例,MRI检查35例,其中B超检出率为42.2%,CT和MR检出率高于B超,分别为60.5%和65.7%,未能检出者均误诊为肝癌或仅诊断肝脏占位性质待定。伴随HBV、HCV及肝硬化17例均被误诊为原发性肝癌或占位性质待查,未检出率100%。45例患者中,3例经肝穿病检证实为局灶性结节增生行定期随访;其余42例均行手术治疗,术后经病理病检确诊,术后康复出院率100%。结论多种影像学检查可提高肝脏少见良性占位检出率,但确诊有赖于病理检查。并非少见良性占位性病变均需手术切除,但因确诊困难,如何避免不必要的手术是目前临床所面临的难题。     

乳腺空芯针活检为不典型导管上皮增生的病理低估研究

目的:计算乳腺空芯针穿刺活检(core needle biopsy,CNB)诊断为不典型导管上皮增生(atypical ductal hyperplasia,ADH)病人的病理低估率。分析病人临床及影像学信息,探讨低估的预测因素。方法:回顾性分析2010年1月至2013年2月期间,本中心60例CNB诊断为ADH病人。定义病理低估为CNB是ADH但切除活检诊断是恶性的。以卡方检验、Fisher精确检验和二分类Logistic回归分析病理低估的预测因素。结果:本研究60例CNB诊断为ADH病人的病理低估率为65.0%(39/60)。乳腺X线检查发现恶性征象的微钙化(OR=7.988,95%CI:4.997~12.810,P=0.001)、乳腺X线检查影像报告数据系统(BI-RADS)≥4级(OR=10.875,95%CI:2.747~43.051,P     

内镜黏膜下剥离术治疗早期结直肠癌及癌前病变的非整块切除影响因素分析

目的 探讨内镜黏膜下剥离术(endoscopic submucosal dissection, ESD)治疗结直肠肿瘤发生非整块切除的影响因素。方法 回顾性收集2011年1月～2022年12月结直肠ESD临床病理资料,经病理证实为腺瘤、锯齿状病变、早期结肠癌共1251例患者1312个病变,比较整块切除组与非整块切除组的临床病理特征,采用单因素及多因素logistic回归分析ESD非整块切除的影响因素。结果 1312个病变长径(25.8±16.3)mm。腺瘤728个(55.5%),锯齿状病变193个(14.7%),腺癌391个(29.8%)。1306个病变完成ESD治疗,因穿孔或操作困难中止切除6个。病变整块切除率89.5%(1174/1312),完全切除率73.8%(968/1312),治愈性切除率70.6%(926/1312)。多因素logistic分析显示,病变长径≥40 mm(OR=6.329,95%CI:4.278～9.384,P<0.001)、抬举征阴性(OR=2.384,95%CI:1.424～3.903,P=0.005)、瘢痕部位病变(OR=2.997,95%CI:...     

术前临床指标对肝细胞癌患者微血管侵犯分级的预测价值

目的 通过对根治性肝切除患者术前临床指标综合分析构建术前预测模型,预测肝细胞癌（HCC）患者是否合并微血管侵犯（MVI）,并验证其预测效能。方法 对2017年3月至2022年6月在南京鼓楼医院肝胆外科收治的579例肝切除HCC患者的临床资料进行回顾性研究,根据手术时间顺序分为模型组279例和验证组300例。采用单因素与多因素Logistic回归分析术前临床指标影响MVI分级的独立危险因素,并建立预测评分模型,通过ROC曲线判断MVI的诊断价值,并在验证组中进行独立验证。结果多因素Logistic回归分析显示,肿瘤最大径>5 cm(OR=8.356,95%CI 3.950～17.675,P<0.001)、肿瘤数目为多个（OR=8.652,95%CI 3.213～23.302,P<0.001）、肿瘤包膜强化（OR=4.636,95%CI 2.266～9.483,P<0.001）及AFP>400μg/L(OR=8.938,95%CI 4.182～19.105,P<0.001)为MVI分级的独立危险因素。根据Logistic回归分析结果构建预测模型,ROC曲...     

Xp11.2易位/TFE3基因融合相关性肾癌1例报告及文献复习

目的:探讨Xp11.2易位/TFE3基因融合相关性肾癌的临床表现、诊断及治疗方法。方法:回顾性分析2005年12月~2015年12月收治的1例病理诊断为Xp11.2易位/TFE3基因融合相关性肾癌患者的临床资料,并结合最新文献对本病的流行病学、病理学、影像学以及治疗和预后进行总结分析。结果:CT显示肾占位病变,B超检查考虑为错构瘤可能性大。术中冷冻切片病理检查为肾癌,行后腹腔镜肾癌根治性切除术,术后未行其他辅助治疗。病理检查诊断为Xp11.2易位/TFE3基因融合相关性肾癌。随访12个月,未见明显复发或进展征象。结论:Xp11.2易位/TFE3基因融合相关性肾癌是一种临床罕见的易位性肾癌,主要发病于儿童和年轻人。确诊依赖于病理学和免疫组织化学;根治性手术切除为主要治疗方法,预后较差。     

Benign pathological findings in 303 Chinese patients undergoing surgery for presumed localized renal cell carcinoma

Objective: To analyze the incidence of benign lesions in Chinese patients undergoing nephrectomies for renal masses identified as localized renal cell carcinoma (RCC) in preoperative imaging. Methods: Between 1999 and 2007, 303 patients (112 female, 191 male) with presumed localized RCC underwent nephrectomy (234 radical nephrectomies and 69 partial nephrectomies). Preoperative computed tomography images and pathological findings were reviewed and analyzed. Results: Pathological examinations revealed 31 (10.2%) benign lesions in the 303 patients. Among these 31 benign lesions, 15 (5.0%) were angiomyolipomas (AML) and only four (1.3%) were oncocytomas. Significantly, 20 (17.9%) of the 112 female patients had benign lesions compared with 11 (5.8%; P = 0.001) male patients. Benign renal lesions were found in five (25.0%) of the 20 patients with renal masses smaller than 2 cm, 13 (13.0%) of the 100 patients with renal masses 2–4 cm in size and 13 (7.1%) of the 183 patients with renal masses larger than 4 cm. Conclusions: Patients in the present study population show a low incidence of benign renal lesions, approximately half of them being AML. Female patients and patients with renal masses smaller than 4 cm are more likely to have benign renal lesions.     

Predictive value of renal tumor contour irregularity score in pathological T3a upstaging of clinical T1 renal cell carcinoma: A multi-institutional study

PurposeTo explore the predictive value of renal tumor contour irregular degree (CID) in pathological T3a upstaging of clinical T1 renal cell carcinoma (RCC).Materials and methodsWe performed a retrospective multi-institutional review of 1,487 patients with clinical T1N0M0 RCC between January 2009 and June 2019. Kaplan-Meier survival curve and Cox regressions were used to analyze the prognostic factors of disease-free survival (DFS). Logistic regressions were performed to determine predictors of pathological T3a upstaging in clinical T1 RCC.ResultsAmong 1,487 patients with cT1 RCC, 96 (6.5%) were pathological T3a upstaging. Multivariable logistic regression analysis showed that age (odds ratio [OR] = 1.022, 95% confidence interval [CI] = 1.001–1.042, P = 0.036), tumor maximum diameter(OR = 1.242, 95% CI = 1.042-–1.480, P = 0.015) and CID (OR = 1.067, 95% CI = 1.051–1.083, P < 0.001) were independent predictors of pathological T3a upstaging. The area under the curve (AUC) of the prediction model that included the CID was 0.846, while the AUC of the prediction model that did not include CID was only 0.741, the difference was statistically significant (P < 0.001). Kaplan-Meier survival curve showed that patients with pathological T3a upstaging had significantly worse DFS than patients without pathological T3a upstaging (P < 0.001). Multivariable Cox analysis showed that pathological T3a upstaging (HR = 1.836, 95% CI = 1.013–3.329, P = 0.002) is an independent prognostic factor for DFS in patients with cT1N0M0 RCC.ConclusionsThe predictive model of CID combined with tumor maximum diameter and age significantly improved the ability to predict pathological T3a upstaging in clinical T1 RCC, compared with the prediction model of tumor maximum diameter combined with age. The predictive model of CID combined with tumor maximum diameter and age may be applicable to patients considering partial vs. radical nephrectomy.     

Factors associated with surgery in patients with renal cell carcinoma and venous tumor thrombus

Study Type – Therapy (case series) Level of Evidence 4 What’s known on the subject? and What does the study add? This is the first published report which is an in‐depth analysis of factors associated with surgery versus non‐operative management in patients with renal cell carcinoma and venous tumour thrombus.

OBJECTIVE

? Venous tumour thrombus is common in patients with renal cell carcinoma (RCC). Although surgical morbidity has decreased with time, nephrectomy with caval thrombectomy remains a high‐risk procedure and may not be performed in all patients with this condition. Little is known about the factors influencing the decision to pursue surgery versus conservative management in patients with RCC and venous tumour thrombus.

MATERIALS AND METHODS

? The Surveillance, Epidemiology, and End Results database was used to identify study patients with RCC and venous tumour thrombus. ? Multiple clinical, pathological and sociodemographic variables were assessed. ? Univariable and multivariable logistic regression analysis was performed to identify factors associated with surgery.

RESULTS

? We identified 24 396 patients with RCC, of which 2265 (9.3%) had venous tumour thrombus. ? Distant metastases (odds ratio [OR] 0.1, 95% CI 0.0–0.1), clinical stage T3c (OR 0.3, 95% CI 0.2–0.6), lymph node involvement (OR 0.4, 95% CI 0.2–0.6), being single (OR 0.4, 95% CI 0.3–0.7), and the age categories 61–70 years (OR 0.4, 95% CI 0.2–0.8, P= 0.01), 71–80 years (OR 0.2, 95% CI 0.1–0.3, P < 0.001), and ≥80 years (OR 0.1, 95% CI 0.0–0.1, P < 0.001) were significantly associated with non‐surgical management.

CONCLUSIONS

? In this population‐based study, over 80% of patients with RCC and venous tumour thrombus underwent surgical management. ? Although age and TNM stage were strongly associated with the decision to undergo surgery, marital status was also associated with treatment choice. ? It is unclear whether marital status affects oncological outcomes or complication rates so the reasons behind this association deserve further investigation.     

Trends in renal cancer surgery and patient provider characteristics associated with partial nephrectomy in the United States

OBJECTIVE: Many renal tumors are amenable to either partial or total nephrectomy, but little is known about the relative frequency that these procedures are performed in the United States. We describe recent temporal trends in surgery for renal neoplasm and identified factors associated with partial nephrectomy. METHODS: Data from the 1998 through 2002 National Inpatient Sample was analyzed to identify adult patients discharged after renal cancer surgery. The frequency of partial and total nephrectomy in the United States was estimated, and multivariate regression was used to examine patient and provider factors associated with partial nephrectomy. RESULTS: The number of nephrectomies performed for tumor in the United States increased yearly, with an estimated 23,375 total nephrectomies and 4272 partial nephrectomies performed in 2002. The ratio of partial nephrectomies to total nephrectomies also increased (P < 0.001), with partial nephrectomy representing 15.5% of all nephrectomies in 2002. In the multivariate analysis, patient and provider factors significantly associated with undergoing partial nephrectomy included female sex (odds ratio [OR] = 0.86, 95% confidence interval [CI] 0.79-0.94), age (OR = 0.38, 95% CI 0.30-0.49 comparing age older than 79 to younger than 40 years), teaching hospital status (OR = 1.54, 95% CI 1.34-1.76), annual hospital nephrectomy volume (OR = 1.96, 95% CI 1.62-2.39 comparing highest to lowest quartiles), annual surgeon nephrectomy volume (OR = 2.60, 95% CI 2.12-3.20 comparing highest to lowest quartiles), and private insurance/health maintenance organization coverage (OR = 1.25, 95% CI 1.11-1.40 compared to Medicare). CONCLUSIONS: The total number of nephrectomies and the proportion of partial nephrectomies performed in the United States increased yearly from 1998 to 2002. Male sex, hospital teaching status, higher hospital and surgeon volume, and insurance status are associated with receiving partial nephrectomy.     

Tumour location as a predictor of benign disease in the management of renal masses

Objective:

To investigate the association between tumour location and the proportion of benign disease in renal masses presumed to be renal cell carcinoma (RCC) preoperatively.

Methods:

This Institutional Review Board approved study includes 196 patients who underwent surgical treatment for renal masses <5 cm at our institution by a single surgeon between January 2002 and June 2009. Based on preoperative imaging, each mass was designated as central (touching or encroaching upon the renal collecting system and/or renal sinus) or peripheral. The association between tumour location and benign pathology was determined using univariate and multiple logistic regression, including tumour size and patient sex in the model.

Results:

The proportion of histologically confirmed benign disease in this series was 11.2%. The proportion of benign disease by location was 5.9% and 19.5% for central and peripheral masses, respectively. The effect of location was found to have a significant prognostic value (p = 0.0273) with an adjusted odds ratio of 3.51 (95% CI = 1.38–19.62) for the odds of a benign diagnosis in peripheral compared to central tumours. Tumour size and patient sex were not significant predictors of benign pathology (p = 0.483 and 0.191, respectively).

Conclusions:

Peripherally located renal masses are more likely to be benign than centrally located renal masses. This information may be used when selecting strategies for the management of renal masses presumed to be RCC.     

Race and sex disparities in the treatment of older patients with T1a renal cell carcinoma: A comorbidity-controlled competing-risks model

ObjectivesRecognizing population-level disparities for the treatment of patients with renal cell carcinoma (RCC) would inform clinical practice and health policy. Few studies, reporting conflicting results, have investigated race and sex disparities specifically among patients with small renal masses.Methods and materialsThe Surveillance, Epidemiology, and End Results-Medicare database (1995–2007) was queried for patients with localized T1a RCC undergoing radical nephrectomy, partial nephrectomy (PN), or deferred therapy (DT). Demographics, comorbidity, and treatment approach were assessed. Multivariable logistic regression models evaluated predictors of DT and then PN among those receiving surgery. Cox proportional hazards model evaluated survival differences for whites vs. blacks and women vs. men.ResultsA total of 6,092 white and 617 black patients with T1a RCC met the inclusion criteria. Blacks were twice as likely to defer therapy compared with whites (odds ratio = 1.95, 95% CI: 1.52–2.51) and had worse overall survival (hazard ratio = 1.36, 95% CI: 1.19–1.56). However, cancer-specific survival (CSS) was similar (P = 0.429). The greatest discrepancy was among healthy (Charlson comorbidity index≤1) blacks who had a much higher rate of DT compared with their white counterparts. Women were found to have decreased use of PN compared with men (odds ratio = 0.84, 95% CI: 0.74–0.96) and better CSS (hazard ratio = 0.74, 95% CI: 0.58–0.94), but there were no differences by race.ConclusionsThe differential use of DT by race instead of purely by age and comorbidity is concerning but has not led to a significant difference in CSS. Women are less likely to undergo PN compared with men, but they also have a notably improved CSS.     

A comparison of perinephric fat surface area and Mayo Adhesive Probability score in predicting malignancy in T1 renal masses

Introduction

Recent studies have proposed that nearby fat deposits may have metabolic influence on kidney cancer pathobiology. Both fat quantity and quality may play unique roles in this complex relationship. As such, we investigated whether perinephric fat surface area (PFA), a quantitative measure of fat, or Mayo Adhesive Probability (MAP) score, a qualitative measure, were predictive of malignant pathology or Fuhrman grade in small renal masses.

Delaying surgery for clinical T1b-T2bN0M0 renal cell carcinoma: Oncologic implications in the COVID-19 era and beyond

PurposeDuring COVID-19, many operating rooms were reserved exclusively for emergent cases. As a result, many elective surgeries for renal cell carcinoma (RCC) were deferred, with an unknown impact on outcomes. Since surveillance is commonplace for small renal masses, we focused on larger, organ-confined RCCs. Our primary endpoint was pT3a upstaging and our secondary endpoint was overall survival.Materials and methodsWe retrospectively abstracted cT1b-T2bN0M0 RCC patients from the National Cancer Database, stratifying them by clinical stage and time from diagnosis to surgery. We selected only those patients who underwent surgery. Patients were grouped by having surgery within 1 month, 1–3 months, or >3 months after diagnosis. Logistic regression models measured pT3a upstaging risk. Kaplan Meier curves and Cox proportional hazards models assessed overall survival.ResultsA total of 29,746 patients underwent partial or radical nephrectomy. Delaying surgery >3 months after diagnosis did not confer pT3a upstaging risk among cT1b (OR = 0.90; 95% CI: 0.77–1.05, P = 0.170), cT2a (OR = 0.90; 95% CI: 0.69–1.19, P = 0.454), or cT2b (OR = 0.96; 95% CI: 0.62–1.51, P = 0.873). In all clinical stage strata, nonclear cell RCCs were significantly less likely to be upstaged (P <0.001). A sensitivity analysis, performed for delays of <1, 1–3, 3–6, and >6 months, also showed no increase in upstaging risk.ConclusionDelaying surgery up to, and even beyond, 3 months does not significantly increase risk of tumor progression in clinically localized RCC. However, if deciding to delay surgery due to COVID-19, tumor histology, growth kinetics, patient comorbidities, and hospital capacity/resources, should be considered.     

Low incidence of benign lesions in resected suspicious renal masses greater than 2 cm: Single‐center experience from Japan

Objective: To assess the incidence of benign renal lesions in our Japanese clinical experience with surgical resection. Methods: A total of 411 renal masses harvested by radical or partial nephrectomy between January 1991 and April 2011 at our institution were retrospectively assessed. The incidence of benign lesions in 1‐cm increments in diameter was determined, and a logistic regression model was used to assess relationships between the incidence of benign lesions and other factors. Results: Histological examination confirmed a total of 18 (4.4%) benign lesions. The incidence of benign lesions was 42.8% for nodules <1 cm and 10.0% for nodules 1 to <2 cm. In contrast, the incidence of benign lesions in each 1‐cm increment between 2 and 6 cm was 4.1–4.9%. The incidence of benign lesions 2 to <4 cm was 4.8% and of benign nodules ≥6 cm was just 0–1.0%. The incidence of benign lesions ≥2 cm (3.5%) was significantly lower than that of masses <2 cm (16.2%; P < 0.001). Multivariate analysis showed that female gender (odds ratio 3.68) and smaller mass size (<2 cm; odds ratio 4.84) were significant predictors for benign lesions. Conclusions: The incidence of benign lesions among renal masses ≥2 cm in diameter was found to be much lower than previously reported. This should be taken into account when designing strategies for the management of suspicious small renal masses.     

Histotype predicts the rate of lymph node invasion at nephrectomy in patients with nonmetastatic renal cell carcinoma

BackgroundLymph node invasion (LNI) at nephrectomy is one of the most important predictors of mortality in patients with nonmetastatic renal cell carcinoma (RCC). We analyzed the effect of histology on lymph node metastases at nephrectomy and its effect on survival in a contemporary cohort of patients with nonmetastatic RCC.MethodsWithin the Surveillance, Epidemiology, and End Results database (2004-2015), we identified 100,060 patients with clear-cell, papillary, chromophobe, sarcomatoid, and collecting duct RCC, who underwent nephrectomy with or without lymph node dissection for nonmetastatic RCC. Logistic regression models, cumulative incidence plots, and competing-risks regression models were performed.ResultsOverall, 10,590 patients underwent lymph node dissection for nonmetastatic RCC. Of these, LNI was recorded in 52 (7.0%), 615 (8.7%), 282 (13.9%), 316 (25.1%), 129 (38.3%), 45 (71.4%) patients with chromophobe, clear-cell, nonotherwise specified RCC, papillary, sarcomatoid, and collecting duct RCC histological subtypes, respectively. In logistic regression models, relative to clear-cell, papillary Odds ratio (OR 3.9), sarcomatoid (OR 6.3), collecting duct (OR 14.6) but not chromophobe RCC (OR 0.9; P = 0.5) independently predicted LNI at surgery. Moreover, in competing-risks regression models, LNI increased the risk of CSM 1.8-fold for sarcomatoid, 3.6-fold for clear-cell, 4.1-fold for papillary, and 6.7-fold for chromophobe histological subtype.ConclusionsHistology is an independent predictor of increased risk of LNI at nephrectomy. Moreover, the effect of pathological nodal stage on survival differs according to different histology.