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Renal kitle nedeniyle radikal nefrektomi yapılan hastaların tümör karakteristiklerinin değerlendirilmesi; 18 yıllık sonuçlarımız

Year 2019, Volume: 26 Issue: 3, 288 - 294, 01.09.2019
https://doi.org/10.17343/sdutfd.460209

Abstract

Amaç: Süleyman Demirel Üniversitesi Tıp
Fakültesi’nde 18 yıllık süreçte böbrekte kitle nedeniyle radikal nefrektomi
yapılan hastaların demografik özelliklerinin, tümör histopatolojilerinin ve
bunların birbirleriyle ilişkisinin incelenmesi.



Gereç ve Yöntem: Şubat 2000- Kasım2017 arasında Süleyman
Demirel Üniversitesi Üroloji Klinigi’ne başvuran ve böbrekte kitle tanısıyla
radikal nefrektomi yapılan 245 hastanın verileri incelendi. Hastaların yaşı,
cinsiyeti, preoperatif görüntülemedeki lezyon boyutu, patolojik lezyon boyutu,
patolojik tanısı, varsa histolojik subtipi ve fuhrman derecesi, mikrovasküler
invazyon, sinir invazyonu, sürrenal invazyonu, lenf nodu invazyonu, tümör nekrozu,
eşlik eden piyelonefrit verileri değerlendirildi. Hastaların demografik
özelliklerinin yanısıra, yaş ile klinik tümör evresi arasındaki ilişki, histolojik  subtip ile patolojik evre arasındaki ilişki,
metastaz ile tümör boyutu arasındaki ilişki, tümör nekrozu ile patolojik evre
arasındaki ilişki, tümöre eşlik eden piyelonefrit ile patolojik evre arasındaki
ilişki, mikrovasküler invazyon ile
patolojik evre arasındaki ilişki ve sinir invazyonu ile patolojik evre
arasındaki ilişkiler iki değişkenli korelasyon analizi ile ayrı ayrı değerlendirildi. Anlamlılık değeri olarak p<0,05 kabul edildi. Anlamlı saptanan ilişkilerin basit
doğrusal regresyon analizi ile
anlamlılık dereceleri (r değerleri) saptandı.  



Bulgular: İncelenen 245 hastanın ortalama yaşı
61,26 olarak bulundu. Renal kitle nedeniyle opere edilen hastalardan; 202
hastada (%82,44) renal hücreli karsinom (RHK), 13 hastada (%5,30) RHK dışı kanser (skuamöz hücreli ya
da transizyonel hücreli), 11 (%4,48) hastada onkositom, 1 (%0,40) hastada
anjiyomiyolipom, 3 (%1,22) hastada adenom, 6 (%2,44) hastada piyelonefrit, 9
(%3,67) hastada komplike kist saptandı.
En
büyük tümör boyutları alındığında ortalama tümör boyutu 7,21 cm olarak bulundu.
38 hastada renal kitle ≤4 cm (T1a), 90 hastada >4- ≤7
cm arasında (T1b), 77 hastada >7- ≤ 10 cm (T2a), 40 hastada 10 cm den büyük
(T2b) saptandı.
Metastaz
olan 26 hastada fuhrman derecesi 3 ya da 4, 8 hastada fuhrman derecesi 1 ya da
2 olarak bulundu. Klinik tümör evresi ile yaş arasında bir ilişki saptanmadı.
Histolojik subtip ile patolojik evre arasında bir ilişki saptanmadı.
Metastaz ile tümör boyutu arasında herhangi bir ilişki saptanmadı. Fuhrman
derecesi ile patolojik evre arasında anlamlı derecede korelasyon saptandı.
Tümör nekrozu, mikrovasküler invazyon ve sinir invazyonu ile patolojik evre
arasında korelasyon saptandı. Eşlik eden piyelonefrit ile patolojik evre
arasında herhangi bir ilişki saptanmadı.



Sonuç: Renal kitlelerin patolojik tanı ve
tedavisinde radikal nefrektomi önemli bir yer tutmaktadır. Tümörün klinik evresine ve histopatolojik özelliklerine bakarak agresifliği hakkında kolayca bilgi
edinilebilir.

References

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  • Chow WH, Dong LM, Devesa SS. Epidemiology and risk factors for kidney cancer. Nature reviews Urology. 2010;7(5):245-57.
  • Clague J, Lin J, Cassidy A, Matin S, Tannir NM, Tamboli P, et al. Family history and risk of renal cell carcinoma: results from a case-control study and systematic meta-analysis. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology. 2009;18(3):801-7.
  • Lindblad P. Epidemiology of renal cell carcinoma. Scandinavian journal of surgery : SJS : official organ for the Finnish Surgical Society and the Scandinavian Surgical Society. 2004;93(2):88-96.
  • Tsivian M, Mouraviev V, Albala DM, Caso JR, Robertson CN, Madden JF, et al. Clinical predictors of renal mass pathological features. BJU international. 2011;107(5):735-40.
  • Moch H, Cubilla AL, Humphrey PA, Reuter VE, Ulbright TM. The 2016 WHO Classification of Tumours of the Urinary System and Male Genital Organs-Part A: Renal, Penile, and Testicular Tumours. European urology. 2016;70(1):93-105.
  • Sobin LH GM, Wittekind C. TNM classification of malignant tumors. UICC International Union Against Cancer. 7th edn ed: Wiley-Blackwell; 2009. 255 p.
  • Sun M, Shariat SF, Cheng C, Ficarra V, Murai M, Oudard S, et al. Prognostic factors and predictive models in renal cell carcinoma: a contemporary review. European urology. 2011;60(4):644-61.
  • Fuhrman SA, Lasky LC, Limas C. Prognostic significance of morphologic parameters in renal cell carcinoma. The American journal of surgical pathology. 1982;6(7):655-63.
  • Znaor A, Lortet-Tieulent J, Laversanne M, Jemal A, Bray F. International variations and trends in renal cell carcinoma incidence and mortality. European urology. 2015;67(3):519-30.
  • Bhatt NR, Davis NF, Flynn R, McDermott T, Thornhill JA, Manecksha RP. Dilemmas in diagnosis and natural history of renal oncocytoma and implications for management. Canadian Urological Association journal = Journal de l'Association des urologues du Canada. 2015;9(9-10):E709-12.
  • Bhatt JR, Richard PO, Kim NS, Finelli A, Manickavachagam K, Legere L, et al. Natural History of Renal Angiomyolipoma (AML): Most Patients with Large AMLs >4cm Can Be Offered Active Surveillance as an Initial Management Strategy. European urology. 2016;70(1):85-90.
  • Farrell C, Noyes SL, Tourojman M, Lane BR. Renal angiomyolipoma: preoperative identification of atypical fat-poor AML. Current urology reports. 2015;16(3):12.
  • Mues AC, Palacios JM, Haramis G, Casazza C, Badani K, Gupta M, et al. Contemporary experience in the management of angiomyolipoma. Journal of endourology. 2010;24(11):1883-6.
  • Schoots IG, Zaccai K, Hunink MG, Verhagen P. Bosniak Classification for Complex Renal Cysts Reevaluated: A Systematic Review. The Journal of urology. 2017;198(1):12-21.
  • Zastrow S, Phuong A, von Bar I, Novotny V, Hakenberg OW, Wirth MP. Primary tumor size in renal cell cancer in relation to the occurrence of synchronous metastatic disease. Urologia internationalis. 2014;92(4):462-7.
  • Lang H, Lindner V, de Fromont M, Molinie V, Letourneux H, Meyer N, et al. Multicenter determination of optimal interobserver agreement using the Fuhrman grading system for renal cell carcinoma: Assessment of 241 patients with > 15-year follow-up. Cancer. 2005;103(3):625-9.
  • Ficarra V, Martignoni G, Maffei N, Brunelli M, Novara G, Zanolla L, et al. Original and reviewed nuclear grading according to the Fuhrman system: a multivariate analysis of 388 patients with conventional renal cell carcinoma. Cancer. 2005;103(1):68-75.
  • Rioux-Leclercq N, Karakiewicz PI, Trinh QD, Ficarra V, Cindolo L, de la Taille A, et al. Prognostic ability of simplified nuclear grading of renal cell carcinoma. Cancer. 2007;109(5):868-74.
  • Delahunt B, Cheville JC, Martignoni G, Humphrey PA, Magi-Galluzzi C, McKenney J, et al. The International Society of Urological Pathology (ISUP) grading system for renal cell carcinoma and other prognostic parameters. The American journal of surgical pathology. 2013;37(10):1490-504.
  • Capitanio U, Cloutier V, Zini L, Isbarn H, Jeldres C, Shariat SF, et al. A critical assessment of the prognostic value of clear cell, papillary and chromophobe histological subtypes in renal cell carcinoma: a population-based study. BJU international. 2009;103(11):1496-500.
  • Karakiewicz PI, Trinh QD, Rioux-Leclercq N, de la Taille A, Novara G, Tostain J, et al. Collecting duct renal cell carcinoma: a matched analysis of 41 cases. European urology. 2007;52(4):1140-5.
  • Delahunt B, Eble JN, McCredie MR, Bethwaite PB, Stewart JH, Bilous AM. Morphologic typing of papillary renal cell carcinoma: comparison of growth kinetics and patient survival in 66 cases. Human pathology. 2001;32(6):590-5.
  • Leibovich BC, Lohse CM, Crispen PL, Boorjian SA, Thompson RH, Blute ML, et al. Histological subtype is an independent predictor of outcome for patients with renal cell carcinoma. The Journal of urology. 2010;183(4):1309-15.
  • Roberts WW, Bhayani SB, Allaf ME, Chan TY, Kavoussi LR, Jarrett TW. Pathological stage does not alter the prognosis for renal lesions determined to be stage T1 by computerized tomography. The Journal of urology. 2005;173(3):713-5.
  • Sorbellini M, Kattan MW, Snyder ME, Reuter V, Motzer R, Goetzl M, et al. A postoperative prognostic nomogram predicting recurrence for patients with conventional clear cell renal cell carcinoma. The Journal of urology. 2005;173(1):48-51.
  • Kim T, Zargar-Shoshtari K, Dhillon J, Lin HY, Yue B, Fishman M, et al. Using percentage of sarcomatoid differentiation as a prognostic factor in renal cell carcinoma. Clinical genitourinary cancer. 2015;13(3):225-30.
  • Sengupta S, Lohse CM, Leibovich BC, Frank I, Thompson RH, Webster WS, et al. Histologic coagulative tumor necrosis as a prognostic indicator of renal cell carcinoma aggressiveness. Cancer. 2005;104(3):511-20.
  • Hakky TS, Baumgarten AS, Allen B, Lin HY, Ercole CE, Sexton WJ, et al. Zonal NePhRO scoring system: a superior renal tumor complexity classification model. Clinical genitourinary cancer. 2014;12(1):e13-8.
Year 2019, Volume: 26 Issue: 3, 288 - 294, 01.09.2019
https://doi.org/10.17343/sdutfd.460209

Abstract

References

  • Moore LE, Wilson RT, Campleman SL. Lifestyle factors, exposures, genetic susceptibility, and renal cell cancer risk: a review. Cancer investigation. 2005;23(3):240-55.
  • Chow WH, Dong LM, Devesa SS. Epidemiology and risk factors for kidney cancer. Nature reviews Urology. 2010;7(5):245-57.
  • Clague J, Lin J, Cassidy A, Matin S, Tannir NM, Tamboli P, et al. Family history and risk of renal cell carcinoma: results from a case-control study and systematic meta-analysis. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology. 2009;18(3):801-7.
  • Lindblad P. Epidemiology of renal cell carcinoma. Scandinavian journal of surgery : SJS : official organ for the Finnish Surgical Society and the Scandinavian Surgical Society. 2004;93(2):88-96.
  • Tsivian M, Mouraviev V, Albala DM, Caso JR, Robertson CN, Madden JF, et al. Clinical predictors of renal mass pathological features. BJU international. 2011;107(5):735-40.
  • Moch H, Cubilla AL, Humphrey PA, Reuter VE, Ulbright TM. The 2016 WHO Classification of Tumours of the Urinary System and Male Genital Organs-Part A: Renal, Penile, and Testicular Tumours. European urology. 2016;70(1):93-105.
  • Sobin LH GM, Wittekind C. TNM classification of malignant tumors. UICC International Union Against Cancer. 7th edn ed: Wiley-Blackwell; 2009. 255 p.
  • Sun M, Shariat SF, Cheng C, Ficarra V, Murai M, Oudard S, et al. Prognostic factors and predictive models in renal cell carcinoma: a contemporary review. European urology. 2011;60(4):644-61.
  • Fuhrman SA, Lasky LC, Limas C. Prognostic significance of morphologic parameters in renal cell carcinoma. The American journal of surgical pathology. 1982;6(7):655-63.
  • Znaor A, Lortet-Tieulent J, Laversanne M, Jemal A, Bray F. International variations and trends in renal cell carcinoma incidence and mortality. European urology. 2015;67(3):519-30.
  • Bhatt NR, Davis NF, Flynn R, McDermott T, Thornhill JA, Manecksha RP. Dilemmas in diagnosis and natural history of renal oncocytoma and implications for management. Canadian Urological Association journal = Journal de l'Association des urologues du Canada. 2015;9(9-10):E709-12.
  • Bhatt JR, Richard PO, Kim NS, Finelli A, Manickavachagam K, Legere L, et al. Natural History of Renal Angiomyolipoma (AML): Most Patients with Large AMLs >4cm Can Be Offered Active Surveillance as an Initial Management Strategy. European urology. 2016;70(1):85-90.
  • Farrell C, Noyes SL, Tourojman M, Lane BR. Renal angiomyolipoma: preoperative identification of atypical fat-poor AML. Current urology reports. 2015;16(3):12.
  • Mues AC, Palacios JM, Haramis G, Casazza C, Badani K, Gupta M, et al. Contemporary experience in the management of angiomyolipoma. Journal of endourology. 2010;24(11):1883-6.
  • Schoots IG, Zaccai K, Hunink MG, Verhagen P. Bosniak Classification for Complex Renal Cysts Reevaluated: A Systematic Review. The Journal of urology. 2017;198(1):12-21.
  • Zastrow S, Phuong A, von Bar I, Novotny V, Hakenberg OW, Wirth MP. Primary tumor size in renal cell cancer in relation to the occurrence of synchronous metastatic disease. Urologia internationalis. 2014;92(4):462-7.
  • Lang H, Lindner V, de Fromont M, Molinie V, Letourneux H, Meyer N, et al. Multicenter determination of optimal interobserver agreement using the Fuhrman grading system for renal cell carcinoma: Assessment of 241 patients with > 15-year follow-up. Cancer. 2005;103(3):625-9.
  • Ficarra V, Martignoni G, Maffei N, Brunelli M, Novara G, Zanolla L, et al. Original and reviewed nuclear grading according to the Fuhrman system: a multivariate analysis of 388 patients with conventional renal cell carcinoma. Cancer. 2005;103(1):68-75.
  • Rioux-Leclercq N, Karakiewicz PI, Trinh QD, Ficarra V, Cindolo L, de la Taille A, et al. Prognostic ability of simplified nuclear grading of renal cell carcinoma. Cancer. 2007;109(5):868-74.
  • Delahunt B, Cheville JC, Martignoni G, Humphrey PA, Magi-Galluzzi C, McKenney J, et al. The International Society of Urological Pathology (ISUP) grading system for renal cell carcinoma and other prognostic parameters. The American journal of surgical pathology. 2013;37(10):1490-504.
  • Capitanio U, Cloutier V, Zini L, Isbarn H, Jeldres C, Shariat SF, et al. A critical assessment of the prognostic value of clear cell, papillary and chromophobe histological subtypes in renal cell carcinoma: a population-based study. BJU international. 2009;103(11):1496-500.
  • Karakiewicz PI, Trinh QD, Rioux-Leclercq N, de la Taille A, Novara G, Tostain J, et al. Collecting duct renal cell carcinoma: a matched analysis of 41 cases. European urology. 2007;52(4):1140-5.
  • Delahunt B, Eble JN, McCredie MR, Bethwaite PB, Stewart JH, Bilous AM. Morphologic typing of papillary renal cell carcinoma: comparison of growth kinetics and patient survival in 66 cases. Human pathology. 2001;32(6):590-5.
  • Leibovich BC, Lohse CM, Crispen PL, Boorjian SA, Thompson RH, Blute ML, et al. Histological subtype is an independent predictor of outcome for patients with renal cell carcinoma. The Journal of urology. 2010;183(4):1309-15.
  • Roberts WW, Bhayani SB, Allaf ME, Chan TY, Kavoussi LR, Jarrett TW. Pathological stage does not alter the prognosis for renal lesions determined to be stage T1 by computerized tomography. The Journal of urology. 2005;173(3):713-5.
  • Sorbellini M, Kattan MW, Snyder ME, Reuter V, Motzer R, Goetzl M, et al. A postoperative prognostic nomogram predicting recurrence for patients with conventional clear cell renal cell carcinoma. The Journal of urology. 2005;173(1):48-51.
  • Kim T, Zargar-Shoshtari K, Dhillon J, Lin HY, Yue B, Fishman M, et al. Using percentage of sarcomatoid differentiation as a prognostic factor in renal cell carcinoma. Clinical genitourinary cancer. 2015;13(3):225-30.
  • Sengupta S, Lohse CM, Leibovich BC, Frank I, Thompson RH, Webster WS, et al. Histologic coagulative tumor necrosis as a prognostic indicator of renal cell carcinoma aggressiveness. Cancer. 2005;104(3):511-20.
  • Hakky TS, Baumgarten AS, Allen B, Lin HY, Ercole CE, Sexton WJ, et al. Zonal NePhRO scoring system: a superior renal tumor complexity classification model. Clinical genitourinary cancer. 2014;12(1):e13-8.
There are 29 citations in total.

Details

Primary Language Turkish
Subjects Clinical Sciences
Journal Section Araştırma Makaleleri
Authors

Murat Uçar 0000-0002-8690-0485

Sedat Soyupek

Taylan Oksay 0000-0001-9860-5910

Alper Özorak 0000-0003-0926-4216

Ahmet Güzel

Sefa Alperen Öztürk This is me

Murat Demir

Alim Koşar

Publication Date September 1, 2019
Submission Date September 17, 2018
Acceptance Date October 15, 2018
Published in Issue Year 2019 Volume: 26 Issue: 3

Cite

Vancouver Uçar M, Soyupek S, Oksay T, Özorak A, Güzel A, Öztürk SA, Demir M, Koşar A. Renal kitle nedeniyle radikal nefrektomi yapılan hastaların tümör karakteristiklerinin değerlendirilmesi; 18 yıllık sonuçlarımız. Med J SDU. 2019;26(3):288-94.

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