肾肿瘤复杂度评估体系在术前预测肾脏透明细胞癌WHO/ISUP核分级中的应用

Application of renal tumor complexity assessment systems in preoperatively predicting WHO/ISUP nuclear grade of clear-cell renal cell carcinoma

目的评估肾肿瘤复杂度评估体系在术前预测肾脏透明细胞癌WHO/ISUP核分级中的应用。方法回顾性分析复旦大学附属中山医院2017年1月-2019年12月间经术后病理诊断为肾脏透明细胞癌患者1272例。其中男性867例,女性405例;年龄19~86岁,平均58岁;肿瘤位于左肾614例,右肾658例。采用国际上经典的RENAL评分、PADUA评分和中山评分进行量化评估肿瘤复杂性。组织学核分级采用2016年最新推荐的WHO/ISUP分级系统,将WHO/ISUP核分级中Ⅰ~Ⅱ级归为低级别,Ⅲ~Ⅳ级归为高级别。结果1272例患者均顺利完成手术。766例行保留肾单位手术,506例行肾癌根治术;开放手术536例,传统腹腔镜手术433例,机器人辅助腹腔镜手术303例。根据WHO/ISUP核分级,Ⅰ级62例,Ⅱ级963例,Ⅲ级219例,Ⅳ级28例。在RENAL评分中,低、中、高肿瘤复杂度的高WHO/ISUP核分级比例分别为4.0%(11/273)、16.3%(94/576)和33.6%(142/423)。在PADUA评分中,低、中、高肿瘤复杂度的高WHO/ISUP核分级比例分别为2.6%(5/196)、8.3%(21/254)和26.9%(221/822)。在中山评分中,低中高肿瘤复杂度的高WHO/ISUP核分级的比例分别为0.9%(1/109)、6.4%(23/362)和27.8%(223/801)。在三种评分系统中,低中高肿瘤复杂度的高WHO/ISUP核分级所占比例的差异均有统计学意义(P<0.001),但三种评分系统之间差异无统计学意义(P=0.102)。此外,RENAL评分>10分,PADUA评分>12分的肿瘤中,WHO/ISUPⅢ~Ⅳ级所占比例超过50%;中山评分>14分的肿瘤均为WHO/ISUPⅢ~Ⅳ级。结论肾脏透明细胞癌的肿瘤复杂度与WHO/ISUP核分级之间存在正相关。术前联合使用RENAL评分、PADUA评分和中山评分,可以更好地预测肾脏透明细胞癌的WHO/ISUP核分级。

Objective To assess the application of renal tumor complexity assessment systems in preoperatively predicting WHO/ISUP nuclear grade of clear-cell renal cell carcinoma(ccRCC).Methods Between Jan 2017 and Dec 2019,1272 ccRCC patients diagnosed by postoperative pathology in Zhongshan Hospital,Fudan University,including 867 males and 405 females were analyzed retrospectively.The age ranged from 19 to 86 years,with an average of 58 years.The tumors in left and right kidney were observed in 614 and 658 cases,respectively.Renal tumor complexity was quantified using the RENAL score,PADUA score,and Zhongshan score.The histological nuclear grade was assessed by WHO/ISUP classification.WHO/ISUP gradeⅠandⅡwere classified as low grade,and WHO/ISUP gradeⅢandⅣwere classified as high grade.Results All the 1272 patients underwent surgery successfully,including 766 nephron-sparing surgery and 506 radical nephrectomy.Open surgery,traditional laparoscopic surgery and robot-assisted laparoscopic surgery were performed in 536,433 and 303 patients,respectively.According to WHO/ISUP classification,there were 62 patients in gradeⅠ,963 patients in gradeⅡ,219 patients in gradeⅢ,and 28 patients in gradeⅣ.In the RENAL score,the proportions of high WHO/ISUP grade in low,medium and high complexity tumor were 4.0%(11/273),16.3%(94/576)and 33.6%(142/423),respectively.In PADUA score,the proportions of high WHO/ISUP grade in low,medium and high complexity tumor were 2.6%(5/196),8.3%(21/254)and 26.9%(221/822),respectively.In Zhongshan score,the proportion of high WHO/ISUP grade in low,medium and high complexity tumor was 0.9%(1/109),6.4%(23/362)and 27.8%(223/801),respectively.In all the three score systems,the proportions of high WHO/ISUP nuclear grades in low,medium and high complexity tumor were significantly different(P<0.001).However,there was no difference among the three score systems(P=0.102).In addition,WHO/ISUPⅢ-Ⅳaccounted for more than 50%of tumors with RENAL score>10 and PADUA score>12.Tumors with Zhongshan score>14 were all WHO/ISUPⅢ-Ⅳ.Conclusion There is a positive correlation between tumor complexity of ccRCC and WHO/ISUP nuclear grade.The combined application of RENAL score,PADUA score and Zhongshan score can better preoperatively predict WHO/ISUP nuclear grade of ccRCC.