Incidental and symptomatic renal tumors
impact on patient survival
Palavras-chave:
Carcinona, Célula, Renal, Diagnóstico, Incidental, RimResumo
CONTEXTO: O carcinoma de células renais é a terceira neoplasia geniturinária em frequência, havendo atualmente um aumento no diagnóstico incidental de tumores restritos ao rim. OBJETIVO: Verificar a sobrevida dos pacientes com tumores de rim incidentais e sintomáticos submetidos a nefrectomia. TIPO DE ESTUDO: Retrospectivo. LOCAL: Hospital Sírio Libanês e Beneficência Portuguesa de São Paulo. PARTICIPANTES: 115 pacientes com diagnóstico de carcinoma de células renais e operados por um mesmo grupo de cirurgiões, avaliados por um único patologista. VARIÁVEIS ESTUDADAS: Sexo, idade e método diagnóstico, analisados em dois grupos conforme o diagnóstico do tumor: Grupo 1 com diagnóstico incidental e Grupo 2, com tumores sintomáticos. São também avaliadas as características anatomopatológicas da peça operatória e sobrevida dos pacientes nestes dois grupos. Foi realizada análise estatística através do teste t de Student, qui quadrado, log rank test e Kaplan-Meyer. RESULTADOS: Dos pacientes estudados, 59 (51%) tinham diagnóstico incidental, sendo 78% diagnosticados pelo exame ultrasonográfico, 20% por tomografia computadorizada e 2% em transoperatório; já 56 pacientes (49%) apresentaram-se sintomáticos. Houve um equilíbrio quanto à lateralidade, sendo a cirurgia conservadora em 24% dos incidentais e 9% dos sintomáticos. No grupo incidental, apenas um paciente teve progressão e nenhum óbito, ao passo que os sintomáticos tiveram 5 progressões e 10 óbitos. A sobrevida câncer-específica em cinco anos foi de 100% para incidentais e 80% para os sintomáticos (p = 0,001) e a sobrevida livre de doença foi de 98% para os incidentais e 62% para os sintomáticos (p < 0,001). CONCLUSÃO: O tumor de rim diagnosticado incidentalmente oferece melhor prognóstico, proporcionando maior sobrevida livre de doença.
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