Abstract
BackgroundTo evaluate the clinicopathologic value of morphological growth patterns of small renal cell carcinoma (sRCC) and determine the actual demand for taking a rim of healthy parenchyma to avoid positive SM.MethodsData was collected from 560 sRCC patients who underwent laparoscopic surgeries from May 2010 to October 2017. One hundred forty-nine cases received nephron-sparing surgery (NSS) and others received radical nephrectomy (RN). All specimens were analyzed separately by two uropathologists, and three morphological growth patterns were identified. The presence of pseudocapsule (PC), surgical margins (SM), and other routine variables were recorded. The relationship between growth patterns and included variables was measured by the χ2 test and Fisher’s exact probability test. Survival outcomes were evaluated by Kaplan-Meier method and the log-rank test.ResultsThe median age of patients was 63.2 years old and the mean tumor diameter was 3.0 cm. Four hundred eighty (85.7%) cases were clear cell RCC and 541 (96.6%) cases were at the pT1a stage. Peritumoral PC was detected in 512 (92.5%) specimens, and the ratio of tumor invasion in PC in infiltration pattern increased obviously than that of the other growth patterns. Similarly, the pT stage was significantly correlated with the infiltration pattern as well. One hundred forty-nine patients underwent NSS and 3 (2.0%) of them showed positive SM after operation. Statistical differences of the 5-year overall survival (OS) and the cancer-specific survival (CSS) existed between different morphological growth patterns, PC status, and pT stages.ConclusionsMorphological growth patterns of sRCC might be used as a potential biomarker to help operate NSS to avoid the risk of positive SM. How to distinguish different morphological growth patterns before operation and the effectiveness of the growth pattern as a novel proposed parameter to direct NSS in sRCC patients deserves further exploration.
Highlights
To evaluate the clinicopathologic value of morphological growth patterns of small renal cell carcinoma and determine the actual demand for taking a rim of healthy parenchyma to avoid positive surgical margins (SM)
We defined the three growth patterns of small renal cell carcinoma (sRCC) as follows: (I) single nodular pattern (SNP), only one entire tumor lesion exists in the kidney and the margin between tumor and renal parenchyma is clearly visible, and intact peritumoral PC could be observed in most of this type of sRCC (Fig. 1A–C); (II) multinodular fusion pattern (MFP), several masses fuse into a large, well-defined, irregularly shaped mass, which usually separate from each other with connective fibrous tissues, and most of MFP tumors have complete peritumoral PC (Fig. 1D–F); and (III) infiltration pattern (IP), the tumor involves with poorly circumscribed margins with cancer cells extensively infiltrating and unequivocally entrapping normal kidney parenchyma, or the presence of normal renal tissue in the tumor, regardless of tumor circumscription (Fig. 1G–I)
Positive SM was defined as tumor reaching the edge of the specimen that was removed in the case of invasive tumor within 1 mm of the edge of the specimen
Summary
To evaluate the clinicopathologic value of morphological growth patterns of small renal cell carcinoma (sRCC) and determine the actual demand for taking a rim of healthy parenchyma to avoid positive SM. RCC is one of the most malignant tumors among genitourinary diseases, and significant progress in treatments has been achieved during the past 20 years. No research had clarified the histopathological and clinical features of different kinds of morphological growth patterns of sRCC. For this regard, a more practicable classification and treatment strategy that could be utilized for choosing proper therapeutic methods for sRCC patients is necessary. In the past few years, several studies have indicated a reduction of the thickness of safety margins that should be excised with tumor to avoid local recurrence, while some researchers considered the thickness of resection margin is irrelevant with disease progression [7, 8]. The existence of tumor PC is not a standard parameter for pathological analysis so far
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