肾透明细胞癌增强CT表现与病理Fuhrman核分级的关系
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摘要
目的探讨肾透明细胞癌(CCRCC)的增强CT表现与病理Fuhrman核分级之间的关系。方法回顾性分析经手术病理证实的168例肾CCRCC的CT表现,包括肿瘤的密度、大小、瘤内钙化、囊实性、肿瘤边缘及肿瘤强化的CT值,并与Fuhrman病理核分级进行统计学分析。结果不同Fuhrman病理核分级之间肿瘤的强化存在统计学差异(P<0.001)。高级别肿瘤强化程度明显低于低级别肿瘤(P<0.05)。皮质期强化参数预测高级别肿瘤的敏感性为0.82,特异性为0.91。多因素分析:肿瘤边缘不规则、高龄、低强化是高级别肿瘤的3个独立性预测因素。结论 CCRCC的增强CT表现与Fuhrman病理核分级有关,皮质期肿瘤低强化是预测高级别肿瘤的一个独立性因素,能够为临床治疗及预后评估提供帮助。
Objective To investigate the relation between CT features and Fuhrman nuclear grades of clear cell renal cell carcinoma( CCRCC). Methods CT features of 168 patients with CCRCC pathologically confirmed were reviewed retrospectively,including the attenuation value of the lesion,lesion size,calcification within the lesion,cystic versus solid appearance,margin regularity,and CT values of the lesion with enhanced CT. The association between tumor enhancement and Fuhrman grade was analyzed. Results There were significant differences in tumor enhancement among different Fuhrman grades( P < 0. 001).High-grade tumor had significantly lower enhancement( P < 0. 05). The relative enhancement parameters of corticomedullary phase had a sensitivity of 0. 82 and specificity of 0. 91 in prediction of high tumor grade. In the multivariate analysis,irregular margin,more advanced age,and low tumor enhancement were the three independent predictors of high tumor grade. Conclusion Tumor enhancement of CCRCC on multiphase contrast-hanced CT is correlated with Fuhrman grade. Low tumor enhancement in the corticomedullary phase is an independent predictor of high tumor grade. This may be helpful in clinical treatment and prognosis evaluation.
Objective To investigate the relation between CT features and Fuhrman nuclear grades of clear cell renal cell carcinoma( CCRCC). Methods CT features of 168 patients with CCRCC pathologically confirmed were reviewed retrospectively,including the attenuation value of the lesion,lesion size,calcification within the lesion,cystic versus solid appearance,margin regularity,and CT values of the lesion with enhanced CT. The association between tumor enhancement and Fuhrman grade was analyzed. Results There were significant differences in tumor enhancement among different Fuhrman grades( P < 0. 001).High-grade tumor had significantly lower enhancement( P < 0. 05). The relative enhancement parameters of corticomedullary phase had a sensitivity of 0. 82 and specificity of 0. 91 in prediction of high tumor grade. In the multivariate analysis,irregular margin,more advanced age,and low tumor enhancement were the three independent predictors of high tumor grade. Conclusion Tumor enhancement of CCRCC on multiphase contrast-hanced CT is correlated with Fuhrman grade. Low tumor enhancement in the corticomedullary phase is an independent predictor of high tumor grade. This may be helpful in clinical treatment and prognosis evaluation.
引文
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[13]王于臻,刘俊忠,王新华,等.少脂肪肾血管平滑肌脂肪瘤与肾癌的不同影像特征鉴别分析[J].中国中西医结合影像学杂志,2010,8(3):237-239.
[14]Cheng SH,Liu JM,Liu QY,et al.Prognostic role of microvessel density in patients with renal cell carcinoma:a meta-analysis[J].Int J Clin Exp Pathol,2014,7(9):5855-5863.
[15]吴小光,杨宏远,刘建平.CT在不同病理亚型肾细胞癌诊断中的价值[J].医学影像学杂志,2014,24(3):417-420.
[16]Yuan Q,Kapur P,Zhang Y,et al.Intratumor heterogeneity of perfusion and diffusion in clear-cell renal cell carcinoma:correlation with tumor cellularity[J].Clin Genitourin Cancer,2016,14(6):585-594.
[17]于洪伟,牛云,马恩森.肾癌不同亚型CT表现的对照研究[J].医学影像学杂志,2012,22(7):1168-1170.
[18]Lang H,Lindner V,de Fromont M,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[J].Cancer,2005,103:625-629.
[2]Huhdanpaa H,Hwang D,Cen S,et al.CT prediction of the Fuhrman grade of clear cell renal cell carcinoma(RCC):towards the development of computer-assisted diagnostic method[J].Abdom Imaging,2015,40(8):3168-3174.
[3]Steffens S,Roos FC,Janssen M,et al.Clinical behavior of chromophobe renal cell carcinoma is less aggressive than that of clear cell renal cell carcinoma,independent of Fuhrman grade or tumor size[J].Virchows Arch,2014,465(4):439-444.
[4]Fuhrman SA,Lasky LC,Limas C.Prognostic significance of morphologic parameters in renal cell carcinoma[J].Am J Surg Pathol,1982,6:655-663.
[5]Lohse CM,Cheville JC.A review of prognostic pathologic features and algorithms for patients treated surgically for renal cell carcinoma[J].Clin Lab Med,2005,25:433-464.
[6]Choi SY,Sung DJ,Yang KS,et al.Small(<4 cm)clear cell renal cell carcinoma:correlation between CT findings and histologic grade[J].Abdom Radiol(NY),2016,41(6):1160-1169.
[7]Kruk M,Osowski S,Markiewicz T,et al.Computer approach to recognition of Fuhrman grade of cells in clear-cell renal cell carcinoma[J].Anal Quant Cytopathol Histpathol,2014,36(3):147-160.
[8]王超,王龙胜,郑穗生,等.肾透明细胞癌Fuhrman核分级与CT征象的关系[J].中国医学影像技术,2015,31(9):1392-1395.
[9]Zhu YH,Wang X,Zhang J,et al.Low enhancement on multiphase contrast-enhanced CT images:an independent predictor of the presence of high tumor grade of clear cell renal cell carcinoma[J].AJR,2014,203(3):295-300.
[10]Qi LF,Du J,Zhang ZT,et al.Low differentiated microvascular density and low expression of platelet-derived growth factor-BB(PDGF-BB)predict distant metastasis and poor prognosis in clear cell renal cell carcinoma[J].BJU Int,2013,112(4):415-423.
[11]Zhang Y,Kapur P,Yuan Q,et al.Tumor vascularity in renal masses:correlation of arterial spin-labeled and dynamic contrastenhanced magnetic resonance imaging assessments[J].Clin Genitourin Cancer,2016,14(1):25-36.
[12]Yhee JY,Yu CH,Kim JH,et al.Angiogenesis and expression of vascular endothelial growth factor,tumour necrosis factor-αand hypoxia inducible factor-1αin canine?renal cell carcinoma[J].J Comp Pathol,2012,147(2-3):129-138.
[13]王于臻,刘俊忠,王新华,等.少脂肪肾血管平滑肌脂肪瘤与肾癌的不同影像特征鉴别分析[J].中国中西医结合影像学杂志,2010,8(3):237-239.
[14]Cheng SH,Liu JM,Liu QY,et al.Prognostic role of microvessel density in patients with renal cell carcinoma:a meta-analysis[J].Int J Clin Exp Pathol,2014,7(9):5855-5863.
[15]吴小光,杨宏远,刘建平.CT在不同病理亚型肾细胞癌诊断中的价值[J].医学影像学杂志,2014,24(3):417-420.
[16]Yuan Q,Kapur P,Zhang Y,et al.Intratumor heterogeneity of perfusion and diffusion in clear-cell renal cell carcinoma:correlation with tumor cellularity[J].Clin Genitourin Cancer,2016,14(6):585-594.
[17]于洪伟,牛云,马恩森.肾癌不同亚型CT表现的对照研究[J].医学影像学杂志,2012,22(7):1168-1170.
[18]Lang H,Lindner V,de Fromont M,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[J].Cancer,2005,103:625-629.