4 cm 이하의 임상 T1a병기 신세포암에서 크기에 따른 임상 및 병리적 소견

Abstract

Purpose : A small renal cell carcinoma (RCC) detected incidentally without symptom is increased due to the generalization of the ultrasonographic and computed tomography. We evaluated the relationship of pathologic T stage, nuclear grade, histology and presence or absence metastasis according to size of less than 4cm sized RCC. Materials and Methods : We analyzed the medical records and pathology reports of 97 patients with less than 4 cm RCC in preoperative imaging studies who underwent radical nephrectomy or partial nephrectomy from January 1996 to December 2008. The size of the patients were divided into 2 groups, according to size of tumor less than 3.1 cm groups and 3.1-4 cm groups. The pathological T stage, histology, nuclear grade, and metastasis of each groups were investigated. Pathologic T stage were classified according to American Joint Committe on Cancer 2002, and the nuclear grade were assessde by the Fuhrman classification. Results : Less than 3.1 cm groups (A) and 3.1-4 cm (B) groups divided according to the size of RCC were 68 cases (70%) and 29 cases (30%), respectively. When pathologic T stage for each groups were divided into pT1 and pT3, pT1 were 65 cases (95.6%), 21 cases (72.4%), and pT3 were 3 cases (4.4%), 8 cases (27.6%), respectively (Table 2) (p<0.05). When nuclear grade of each groups were divided into the low grade (grade I, II) and the high grade (III, IV), the low grade were 62 cases (81.2%), 19 cases (65.5%), and the high grade were 6 cases (8.8%), 10 cases (34.5%), respectively (Table 2) (p<0.05). When histology of each groups were divided into conventional and non-conventional type, conventional type were 51 cases (75%), 25 cases (86.2%), and non-conventional type were 17 cases (25%), 4 cases (13.8%), respectively (Table 3) (p>0.05). All groups had no metastases at diagnosis. Conclusions : Though size of RCC was less than 4 cm in size, the rates of pT3 stage and high nuclear grade (grade III, IV) was higher in larger tumor size. Thus the size of renal tumor is small, postoperative follow-up was practiced more accurately because difference of malignancy grade was detected by renal tumor size.