小轉移性腎細胞癌的臨床病理特徵
黃裕賓1、黃逸修1,2、林子平1,2、張延驊1,2、林登龍1,2
台北榮民總醫院 泌尿部1；國立陽明大學醫學院 泌尿學科 書田泌尿科學研究中心2
Clinicopathological features of small RCC with concurrent metastasis
Yu-Pin Huang1, Eric Y.H. Huang1,2, Tzu-Ping Lin1,2, Yen-Hwa Chang1,2, Alex T.L. Lin1,2
Department of Urology, Taipei Veterans General Hospital1, Department of Urology, School of Medicine and Shu-Tien Urological Institute, National Yang-Ming University, Taipei, Taiwan2
Purpose
Renal cell carcinoma (RCC) is prone to metastasize. Most metastatic RCC is diagnosed with big tumor size. Smaller RCC usually carries less metastatic risk. We investigated the clinicopathological features and prognosis of small RCC with concurrent metastasis in our hospital.
Materials & Methods
We identified 1057 patients who had undergone surgical resection for renal tumor between 2004 and 2018. Clinicopathological parameters and outcome data of synchronous metastatic small RCC were analyzed.
Results:
From August 2004 to February 2018, 1057 patients were operated for RCC in our hospital. Seven patients (0.66%) with tumor size smaller or equal to 5cm had synchronous metastasis initially and accepted cytoreductive nephrectomy. Mean age was 54 years (range 46-61). Mean tumor size was 3.3cm (range 1.8-4.6). Male to female ratio was 5:2. Five patients had clear cell RCC, and one had Xp11 translocation RCC and the other had high grade mucinous tubular and spindle carcinoma. Mean Fuhrman grade was 3 (range 2-4). Three patients had pT3 tumor and four had pT1 tumor. All had single organ metastasis at initial diagnosis. Five of these patients had bone metastasis with initial symptom of back pain. One had lung metastasis and the other had mediastinum metastasis. The median follow-up period was 15 months (range 4-101). Three patients died during follow-up and mean overall survival time is 16 months (range 9-20).
Conclusion:
Small RCC with synchronous metastasis at presentation is not common. ccRCC was the most common subtype. The most metastatic organ was bone. Despite of the small tumor size, advanced tumor stage and grade was found in our series. The prognosis was disastrous.