临床T1期肾细胞癌肾窦侵犯的危险因素

doi:10.19723/j.issn.1671-167X.2021.04.006

摘要/Abstract

摘要：

目的: 总结临床T1(cT1)期肾细胞癌的临床影像学特点,探究影响cT1期肾细胞癌患者发生肾窦侵犯的危险因素。方法: 回顾性分析2016年1月至2019年8月于北京大学第三医院泌尿外科住院行肾部分切除术或根治性肾切除术,术前诊断为cT1期肾细胞癌的患者,收集患者的临床、影像学和病理学资料。采用卡方检验、Mann-Whitney U检验、多因素Logistic回归,对cT1期肾细胞癌发生肾窦侵犯的相关危险因素进行分析。结果: 共纳入507例患者,其中男性354例(69.8%),女性153例(30.2%),中位年龄59岁,中位体重指数25.5 kg/m²。术前有肉眼血尿者18例(3.6%),中位肿瘤直径3.5 cm。cT1a期322例(63.5%),cT1b期185例(36.5%),中位R.E.N.A.L.评分为8分。肿瘤边界规则者359例(70.8%),肿瘤边界不规则者148例(29.2%)。所有患者均行手术治疗,包括186例(36.7%)肾部分切除术和321例(63.3%)根治性肾切除术。术后病理提示肾窦侵犯75例(14.8%),其中cT1a期侵犯肾窦18例,占cT1a期总数的5.6%;cT1b期侵犯肾窦57例,占cT1b期总数的30.8%。单因素分析发现,年龄(P=0.02)、R.E.N.A.L.评分(P<0.001)、肿瘤边界状态(P<0.001)是cT1期肾细胞癌发生肾窦侵犯的相关危险因素。多因素Logistic回归显示,R.E.N.A.L.评分(P≤0.020)和肿瘤边界状态(P=0.001)是cT1期肾细胞癌发生肾窦侵犯的独立危险因素。结论: 对cT1期肾细胞癌,术后接近15%的患者存在肾窦侵犯现象;R.E.N.A.L.高评分和肿瘤边界不规则,均可以提示cT1期肾细胞癌有发生肾窦侵犯的风险。

关键词: 肾细胞癌, 肿瘤浸润, 肾窦, 肿瘤分期, 危险因素

Abstract:

Objective: To summarize the clinicoradiological characteristics of clinical T1 renal cell carcinoma patients and to investigate the risk factors of renal sinus invasion in cT1 renal cell carcinoma patients undergoing nephrectomy. Methods: A retrospective study was conducted in cT1 renal cell carcinoma patients from January 2016 to August 2019 in Department of Urology, Peking University Third Hospital, who underwent partial or radical nephrectomy by analyzing clinicopathological and radiological data. The influencing factors of renal sinus invasion for cT1 renal cell carcinoma were determined by χ² test, Mann-Whitney U test and Logistic regression analysis. Results: A total of 507 patients were enrolled, including 354 males (69.8%) and 153 females (30.2%). The median age was 59 years and the median body mass index (BMI) was 25.5 kg/m². Eighteen patients (3.6%) had gross hematuria preoperatively. The median tumor diameter was 3.5 cm. Three hundred twenty-two patients (63.5%) were staged clinical T1a and 165 cases (36.5%) were staged clinical T1b. The median R.E.N.A.L. score was 8. Three hundred fifty-nine patients (70.8%) had regular tumor border and 148 (29.2%) irregular. All the patients underwent surgical treatment, including 186 (36.7%) partial nephrectomy and 321 (63.3%) radical nephrectomy. Postoperative pathology showed seventy-five patients (14.8%) had renal sinus invasion, including 18 in cT1a (5.6%) and 57 in cT1b (30.8%). Univariate analysis showed that age (P=0.020), R.E.N.A.L. score (R value, E value, N value, P<0.001) and tumor border (P<0.001) were associated risk factors for cT1 renal cell carcinoma with renal sinus invasion. On multivariate binary Logistic analysis, R.E.N.A.L. score (P≤0.020) and irregular tumor border (P=0.001) were independent risk factors. Conclusion: For cT1 renal cell carcinoma patients undergoing nephrectomy, about 15% had renal sinus invasion postoperatively. High R.E.N.A.L. score and irre-gular tumor border help predicting cT1 renal cell carcinoma renal sinus invasion.

Key words: Renal cell carcinoma, Neoplasm invasiveness, Renal sinus, Neoplasm staging, Risk factors

中图分类号:

R737.11

孙争辉,黄晓娟,董靖晗,刘茁,颜野,刘承,马潞林. 临床T1期肾细胞癌肾窦侵犯的危险因素[J]. 北京大学学报（医学版）, 2021, 53(4): 659-664.

SUN Zheng-hui,HUANG Xiao-juan,DONG Jing-han,LIU Zhuo,YAN Ye,LIU Cheng,MA Lu-lin. Risk factors of renal sinus invasion in clinical T1 renal cell carcinoma patients undergoing nephrectomy[J]. Journal of Peking University (Health Sciences), 2021, 53(4): 659-664.

图/表 4

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参考文献 27

[1]	Chen WQ, Sun KX, Zheng RS, et al. Cancer incidence and mortality in China, 2014 [J]. Chin J Cancer Res, 2018, 30(1):1-12. doi: 10.21147/j.issn.1000-9604.2018.01.01
[2]	Amin MB, Greene FL, Edge SB, et al. The eighth edition AJCC cancer staging manual: Continuing to build a bridge from a population-based to a more “personalized” approach to cancer staging [J]. CA Cancer J Clin, 2017, 67(2):93-99. doi: 10.3322/caac.21388
[3]	Motzer RJ, Jonasch E, Michaelson MD, et al. NCCN guidelines insights: Kidney cancer, version 2.2020 [J]. J Natl Compr Canc Netw, 2019, 17(11):1278-1285. doi: 10.6004/jnccn.2019.0054
[4]	Ljungberg B, Albiges L, Abu-Ghanem Y, et al. European Association of Urology guidelines on renal cell carcinoma: The 2019 update [J]. Eur Urol, 2019, 75(5):799-810. doi: S0302-2838(19)30152-6 pmid: 30803729
[5]	Renard AS, Nedelcu C, Paisant A, et al. Is multidetector CT-scan able to detect T3a renal tumor before surgery? [J]. Scand J Urol, 2019, 53(5):350-355.
[6]	Ni D, Ma X, Li HZ, et al. Factors associated with postoperative renal sinus invasion and perinephric fat invasion in renal cell can-cer: Treatment planning implications [J]. Oncotarget, 2018, 9(11):10091-10099. doi: 10.18632/oncotarget.v9i11
[7]	Nocera L, Stolzenbach LF, Ruvolo CC, et al. Predicting the risk of pT3a stage in cT1 clear cell renal cell carcinoma [J]. Eur J Surg Oncol, 2021, 47(5):1187-1190. doi: 10.1016/j.ejso.2020.10.040 pmid: 33168336
[8]	Nayak JG, Patel P, Saarela O, et al. Pathological upstaging of clinical T1 to pathological T3a renal cell carcinoma: A multi-institutional analysis of short-term outcomes [J]. Urology, 2016, 94:154-160. doi: 10.1016/j.urology.2016.03.029
[9]	Chen L, Deng W, Liu X, et al. Impact of pathological T3a upstaging on oncological outcomes of clinical T1 renal cell carcinoma: A meta-analysis [J]. J Cancer, 2019, 10(20):4998-5006. doi: 10.7150/jca.32859
[10]	Veccia A, Falagario U, Martini A, et al. Upstaging to pT3a in patients undergoing partial or radical nephrectomy for cT1 renal tumors: A systematic review and meta-analysis of outcomes and predictive factors [J/OL]. Eur Urol Focus, (2020-06-19) [2021-03-02]. https://linkinghub.elsevier.com/retrieve/pii/S2405-4569(20)30148-6
[11]	Shah PH, Moreira DM, Patel VR, et al. Partial nephrectomy is associated with higher risk of relapse compared with radical nephrectomy for clinical stage T1 renal cell carcinoma pathologically up staged to T3a [J]. J Urol, 2017, 198(2):289-296. doi: 10.1016/j.juro.2017.03.012
[12]	Russell CM, Lebastchi AH, Chipollini J, et al. Multi-institutional survival analysis of incidental pathologic T3a upstaging in clinical T1 renal cell carcinoma following partial nephrectomy [J]. Urology, 2018, 117:95-100. doi: 10.1016/j.urology.2018.04.002
[13]	Kutikov A, Uzzo RG. The R.E.N.A.L. nephrometry score: A comprehensive standardized system for quantitating renal tumor size, location and depth [J]. J Urol, 2009, 182(3):844-853. doi: 10.1016/j.juro.2009.05.035
[14]	Patel HD, Gupta M, Joice GA, et al. Clinical stage migration and survival for renal cell carcinoma in the United States [J]. Eur Urol Oncol, 2019, 2(4):343-348.
[15]	Laguna MP, Algaba F, Cadeddu J, et al. Current patterns of pre-sentation and treatment of renal masses: A clinical research office of the endourological society prospective study [J]. J Endourol, 2014, 28(7):861-870. doi: 10.1089/end.2013.0724 pmid: 24555480
[16]	Krishna S, Schieda N, Flood TA, et al. Magnetic resonance imaging (MRI) of the renal sinus [J]. Abdom Radiol (NY), 2018, 43(11):3082-3100.
[17]	Tay MH, Thamboo TP, Wu FM, et al. High R.E.N.A.L. nephrometry scores are associated with pathologic upstaging of cli-nical T1 renal-cell carcinomas in radical nephrectomy specimens: Implications for nephron-sparing surgery [J]. J Endourol, 2014, 28(9):1138-1142. doi: 10.1089/end.2014.0123
[18]	Teishima J, Hayashi T, Kitano H, et al. Impact of radiological morphology of clinical T1 renal cell carcinoma on the prediction of upstaging to pathological T3 [J]. Jpn J Clin Oncol, 2020, 50(4):473-478. doi: 10.1093/jjco/hyz154 pmid: 32100866
[19]	de la Barra CC, Gonzalez PG, Baeza MA, et al. A preoperative model to predict pT3 upstaging in clinically localized renal cell carcinoma [J]. Cent European J Urol, 2020, 73(2):173-177.
[20]	Gorin MA, Ball MW, Pierorazio PM, et al. Outcomes and predictors of clinical T1 to pathological T3a tumor up-staging after robotic partial nephrectomy: A multi-institutional analysis [J]. J Urol, 2013, 190(5):1907-1911. doi: 10.1016/j.juro.2013.06.014
[21]	Mouracade P, Kara O, Dagenais J, et al. Perioperative morbidity, oncological outcomes and predictors of pT3a upstaging for patients undergoing partial nephrectomy for cT1 tumors [J]. World J Urol, 2017, 35(9):1425-1433. doi: 10.1007/s00345-017-2004-x pmid: 28197727
[22]	Ghanie A, Formica MK, Wang D, et al. Pathological upstaging of clinical T1 renal cell carcinoma: An analysis of 115,835 patients from National Cancer Data Base, 2004-2013 [J]. Int Urol Nephrol, 2018, 50(2):237-245. doi: 10.1007/s11255-017-1768-7
[23]	Jeong SH, Kim JK, Park J, et al. Pathological T3a upstaging of clinical T1 renal cell carcinoma: Outcomes according to surgical technique and predictors of upstaging [J]. PLoS One, 2016, 11(11):e0166183. doi: 10.1371/journal.pone.0166183
[24]	Ramaswamy K, Kheterpal E, Pham H, et al. Significance of pathologic T3a upstaging in clinical T1 renal masses undergoing nephrectomy [J]. Clin Genitourin Cancer, 2015, 13(4):344-349. doi: 10.1016/j.clgc.2015.01.001
[25]	Sokhi HK, Mok WY, Patel U. Stage T3a renal cell carcinoma: Staging accuracy of CT for sinus fat, perinephric fat or renal vein invasion [J]. Br J Radiol, 2015, 88(1045):20140504. doi: 10.1259/bjr.20140504 pmid: 25410425
[26]	Jin D, Zhang J, Zhang Y, et al. A combination of the Mayo adhesive probability score and the R.E.N.A.L. score to predict intraoperative complications in small renal masses [J]. Urol Int, 2020, 104(1/2):142-147. doi: 10.1159/000504767
[27]	Tsili AC, Argyropoulou MI. Advances of multidetector computed tomography in the characterization and staging of renal cell carcinoma [J]. World J Radiol, 2015, 7(6):110-127. doi: 10.4329/wjr.v7.i6.110

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Variables	Total (n=507)	cT1a (n=322)	cT1b (n=185)	Z/χ²	P
Age/years, M (P₂₅,P₇₅)	59.0 (48.0, 65.0)	56.5 (47.0, 64.3)	60.0(51-66)	-2.206	0.027
Gender, n(%)				0.001	0.972
Male	354 (69.8)	225 (69.9)	129 (69.7)
Female	153 (30.2)	97 (30.1)	56 (30.3)
BMI/(kg/m²), M (P₂₅, P₇₅)	25.5(23.2, 27.9)	25.1(22.8, 27.9)	26.0(24.1-27.9)	-2.033	0.042
Complains, n(%)				1.399	0.237
Hematuria	18 (3.6)	9 (2.8)	9 (4.9)
Non-hematuria	482 (96.4)	309 (97.2)	175 (95.1)
Tumor side, n(%)				0.001	0.981
Right	247 (48.7)	157 (48.8)	90 (48.6)
Left	260 (51.3)	165 (51.2)	95 (51.4)
Tumor size/cm, M (P₂₅, P₇₅)	3.5 (2.5, 4.6)	2.7 (2.1, 3.4)	5.0(4.4-5.9)	-18.761	<0.001
R.E.N.A.L. score, M (P₂₅,P₇₅)	8 (6, 9)	6 (5, 8)	9 (8-10)	169.419	<0.001
Border, n(%)				-2.483	0.013
Regular	359 (70.8)	272 (84.5)	87 (47.0)
Irregular	148 (29.2)	50 (15.5)	98 (53.0)
LN enlargement,n(%)				1.008	0.315
No	488 (96.3)	312 (96.9)	176 (95.1)
Yes	19 (3.7)	10 (3.1)	9 (4.9)
Surgical strategy, n(%)				185.390	<0.001
RN	186 (36.7)	47 (14.6)	139 (75.1)
PN	321 (63.3)	275 (85.4)	46 (24.9)
Histology, n(%)				4.735	0.860
Clear cell	431 (85.0)	275 (85.4)	156 (84.3)
Papillary	22 (4.3)	11 (3.4)	11 (6.0)
Chromophobe	21 (4.1)	13 (4.0)	8 (4.3)
Others	33 (6.5)	23 (7.1)	10 (5.4)
WHO/ISUP grade, n(%)				6.106	0.013
Ⅰ-Ⅱ	393 (84.1)	256 (87.4)	137 (78.7)
Ⅲ-Ⅳ	74 (15.8)	37 (12.6)	37 (21.3)
RSI, n(%)				59.293	<0.001
Yes	75 (14.8)	18 (5.6)	57 (30.8)
No	432 (85.2)	304 (94.4)	128 (69.2)
PFI, n(%)				6.058	0.014
Yes	19 (3.7)	7 (2.2)	12 (6.5)
No	488 (96.3)	315 (97.8)	173 (93.5)

Variables	NRSI (n=229)	RSI (n=75)	Z/χ²	P
Age/ years, M (P₂₅, P₇₅)	59.0 (47.0, 65.0)	63.0 (55.0, 66.0)	-2.325	0.020
BMI/(kg/m²), M (P₂₅, P₇₅)	25.7 (23.4, 27.8)	24.9 (22.7, 27.5)	-1.108	0.268
Complains, n(%)			0.264	0.853
Hematuria	9 (3.9)	4 (5.3)
Non-hematuria	219 (96.1)	71 (94.7)
Tumor size/cm, M (P₂₅, P₇₅)	4.0 (3.2, 5.1)	4.8 (4.1, 5.7)	-3.782	<0.001
R.E.N.A.L. score, M (P₂₅, P₇₅)	9 (8, 9)	9 (9, 10)	27.509	<0.001
R value, n(%)			16.285	<0.001
1	116 (50.7)	18 (24.0)
2	113 (49.3)	57 (76.0)
E value, n(%)			7.908	0.019
1	82 (35.8)	14 (18.7)
2	94 (41.0)	41 (54.7)
3	53 (23.1)	20 (26.7)
N value, n(%)			20.335	<0.001
2	67 (29.3)	3 (4.0)
3	162 (70.7)	72 (96.0)
A, n(%)			0.042	0.853
Ventricle	110 (48.0)	35 (46.7)
Dorsal	119 (52.0)	40 (53.3)
L value, n(%)			0.408	0.815
1	33 (14.0)	9 (12.0)
2	78 (34.1)	24 (32.0)
3	119 (52.0)	42 (56.0)
Border, n(%)			20.867	<0.001
Regular	151 (65.9)	27 (36.0)
Irregular	78 (34.1)	48 (64.0)
LN enlargement, n(%)			0.034	1.000
No	218 (95.2)	71 (94.7)
Yes	11 (4.8)	4 (5.3)
Histology, n(%)			7.950	0.931
Clear cell	195 (85.2)	65 (86.7)
Non-clear cell	34 (14.8)	10 (13.3)
WHO/ISUP grade, n(%)			0.275	0.600
Ⅰ-Ⅱ	168 (80.0)	58 (81.7)
Ⅲ-Ⅳ	42 (18.3)	12 (16.9)

Items	OR (95%CI)	P value
Age	1.02 (1.00-1.05)	0.062
R value	2.34 (1.15-4.78)	0.020
E value	2.19 (1.39-3.44)	0.001
N value	5.48 (1.59-18.91)	0.007
Border	2.72 (1.47-5.05)	0.001