术前影像诊断肾癌的肾脏良性病变发生率及预测因素分析

目的:研究在中国患者中术前影像学诊断肾癌行肾脏部分切除手术或根治性肾切除手术的肾脏良性占位病变发生率,并分析其预测因素。方法:回顾性分析从2003年1月～2010年9月共1 531例术前影像学诊断为肾癌并行肾脏部分切除手术或根治性肾切除手术患者的临床资料,多因素回归分析术后病理检查证实为良性患者的临床病理资料。结果:在1 531例患者中,共有81例(5.3%)为良性,其中包括错构瘤52例(3.4%),嗜酸细胞腺瘤12例(0.8%),复杂性囊肿6例(0.3%),其他类型11例(0.7%)。单因素分析显示女性、肿瘤最大径较小、年龄较小、囊性占位病变为临床表现者,病理检查证实为良性的可能性大。多因素回归分析显示,女性(OR,3.13;95%CI,1.95～5.04;P<0.001)、肿瘤最大径较小(OR,0.75;95%CI,0.66～0.85;P<0.001)、年龄较小(OR,0.94;95%CI,0.92～0.96;P<0.001)是良性占位病变的独立预测因素,而囊性占位病变不是显著性预测因素。结论:在中国患者中,术前影像学检查诊断为肾癌术后病理检查证实为良性病变的发生率为5.3%,较国外同类研究明显偏低。良性占位病变中最常见的类型为错构瘤,而欧美同类研究中为嗜酸细胞腺瘤。女性、年龄较小、肿瘤最大径较小是良性占位病变的独立预测因素。

Incidence and predictive factors of benign renal lesions in chinese patients with preoperative imaging diagnoses of renal cell carcinoma

Objective:To investigate the prevalence and predictors associated with benign lesions in Chinese patients after partial nephrectomy or radical nephrectomy for presumed renal cell carcinoma(RCC) on preoperative imaging.Methods:We retrospectively investigated the medical records of 1 531 patients who underwent partial nephrectomy or radical nephrectomy for presumed RCC on preoperative imaging between January 2003 and September 2010.Demographic and clinicopathologic parameters were compared between benign lesions and RCC.Logistic regression was done to identify parameters associated with benign lesions.Results:In the 1 531 patients,81 tumors(5.3%) were benign,including 52 angiomyolipomas(3.4%),12 oncocytomas(0.8%),6 complicated cysts(0.3%),and 11 others(0.7%).On univariate analysis,the proportion of benign lesions was significantly higher in female patients,and in patients with smaller tumors,cystic renal masses,and with younger age as a presenting symptom.On multiple logistic regression analysis,female sex(OR,3.13;95% CI,1.95-5.04;P<0.001),age(OR,0.94;95% CI,0.92-0.96;P<0.001),and tumor size(OR,0.75;95% CI,0.66-0.85;P<0.001) were independent predictors of benign histologic features.Cystic renal masses were not signi?cant predictors(P>0.05).Conclusions:The findings in this large cohort of Chinese patients show a lower incidence(5.3%) of benign renal lesions than those of previous Western reports.The most common benign lesion was angiomyolipoma,compared with oncocytoma in Western countries.Female gender,younger age,and smaller tumor size are independent predictors of benign histological features.