CAJ | 학술논문

目的研究肾脏实质性肿瘤通过CT测量的最大径与术后病理最大径之间的差异.方法回顾性分析2008年9月至2010年9月在上海交通大学附属仁济医院行肾脏肿瘤手术且临床病理资料完整的204例患者的资料,采用配对t检验比较平均CT最大径与病理最大径之间的差异,分析其差异与术后病理分期和病理类型的关系.结果 204例患者的肿瘤平均CT最大径为48.3mm,平均病理最大径为47.0 mm,差值为1.3 mm,差异有统计学意义(P=0.018).其中CT最大径较病理最大径增大者111例(54.4％),减小者71例(34.8％),相等者22例(10.8％).在190例病理分期为pT1和pT2期的患者中,有35例(18.4％)患者的术后病理分期改变,其中29例(15.3％)患者术后分期下降,6例(3.2％)患者分期上升.以分期相关大小分层分析的结果显示,CT最大径为41～70 mm肿瘤的平均CT最大径较平均病理最大径大1.76 mm,且差异有统计学意义(P =0.035).以病理类型分层分析的结果显示,肾透明细胞癌的平均CT最大径较平均病理最大径大1.69 mm,且差异有统计学意义(P =0.003).结论肾脏肿瘤的CT最大径与病理最大径之间存在明显差异,差值为1.3mm.二者的差异会导致部分患者出现术后病理分期的改变,这可能会对临床医师的术前临床决策及预后判断产生一定影响.
목적 연구신장실질성종류통과CT측량적최대경여술후병리최대경지간적차이.방법 회고성분석2008년9월지2010년9월재상해교통대학부속인제의원행신장종류수술차림상병리자료완정적204례환자적자료,채용배대t검험비교평균CT최대경여병리최대경지간적차이,분석기차이여술후병리분기화병리류형적관계.결과 204례환자적종류평균CT최대경위48.3mm,평균병리최대경위47.0 mm,차치위1.3 mm,차이유통계학의의(P=0.018).기중CT최대경교병리최대경증대자111례(54.4％),감소자71례(34.8％),상등자22례(10.8％).재190례병리분기위pT1화pT2기적환자중,유35례(18.4％)환자적술후병리분기개변,기중29례(15.3％)환자술후분기하강,6례(3.2％)환자분기상승.이분기상관대소분층분석적결과현시,CT최대경위41～70 mm종류적평균CT최대경교평균병리최대경대1.76 mm,차차이유통계학의의(P =0.035).이병리류형분층분석적결과현시,신투명세포암적평균CT최대경교평균병리최대경대1.69 mm,차차이유통계학의의(P =0.003).결론 신장종류적CT최대경여병리최대경지간존재명현차이,차치위1.3mm.이자적차이회도치부분환자출현술후병리분기적개변,저가능회대림상의사적술전림상결책급예후판단산생일정영향.
Objective To investigate the differences between tumor sizes measured by preoperative computed tomography (CT) imaging and pathologic examination of surgical specimens in Chinese patients who received extirpative surgery for renal tumors.Methods From September 2008 to September 2010,204 patients with renal tumors treated in the Renji Hospital were enrolled in this study,and their clinicopathological data were collected and analyzed.The paired Student's t-test was used to compare the mean radiological tumor maximum diameter and the mean pathological tumor maximum diameter.All cases in which post-operative down-staging or up-staging occurred due to the discrepancy between radiological and pathological tumor maximum diameters were identified.In addition,the relationship between radiological and pathological tumor maximum diameters and histological subtypes was analyzed.Results Overall,the radiological mean maximum diameter of tumors on CT was 48.3 mm and the pathological mean maximum diameter was 47.0 mm.On average,CT overestimated pathological size by 1.3 mm (P =0.018).CT overestimated pathological tumor size in 111 (54.4％) patients,underestimated in 71 (34.8％) patients and equal pathological size in 22 (10.8％) patients.Among the 190 patients with pT1 or pT2 tumors,there was a discrepancy between clinical and pathological staging in 35 (18.4％) patients.Of these,29 (15.3％)patients were down-staged post-operatively and 6 (3.2％) were up-staged.When subjects were categorized according to radiographic tumor size associated with clinical stage,statistically significant difference (average of 1.76 mm) was observed between radiographic and pathologic maximum diameters ranging 41-70 mm (P =0.035).For clear cell carcinoma,mean radiographic tumor maximum diameter was significantly larger than the pathologic maximum diameter by 1.69 mm (P =0.003).Condusions There is a statistically significant but small difference (1.3 rmm) between mean radiological and mean pathological tumor maximum diameters.For some patients,this difference leads to a discrepancy between clinical and pathological staging,which may have implications on pre-operative clinical decision and prognosis prediction.