Investigative and Clinical Urology

The Korean Urological Association (대한비뇨의학회)
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Does epithelioid angiomyolipoma have poorer prognosis, compared with classic angiomyolipoma?

  • Lee, Wonchul (Department of Urology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Choi, Se Young (Department of Urology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Chanwoo (Department of Urology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Yoo, Sangjun (Department of Urology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • You, Dalsan (Department of Urology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Jeong, In Gab (Department of Urology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Song, Cheryn (Department of Urology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Kun Suk (Department of Urology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Hong, Bumsik (Department of Urology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Hong, Jun Hyuk (Department of Urology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Ahn, Hanjong (Department of Urology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Choung-Soo (Department of Urology, Asan Medical Center, University of Ulsan College of Medicine)
  • Received : 2018.07.09
  • Accepted : 2018.08.27
  • Published : 2018.11.10
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Abstract

Purpose: Classic angiomyolipoma (AML) is common benign kidney tumor. However, some studies have claimed that epithelioid angiomyolipoma (EAML) has malignant potential. We compared the patient characteristics and prognosis of EAML and classic AML to demonstrate predicting factors and poorer prognosis of EAML. Materials and Methods: The medical records of 231 patients who were diagnosed with EAML (n=27, 11.7%) or classic AML (n=204, 88.3%), were reviewed. All patients underwent computed tomography (CT) scans before operation or needle biopsy. We assessed the age, sex, tumor size, body mass index, comorbidities, and Hounsfield unit (HU) according to each CT phase. We defined the unfavorable group as patients with recurrence, metastasis and death due to tumor progression. Logistic regression analysis was used to predict EAML. Results: EAML patients were younger (41.2 years vs. 49.1 years, p=0.001), predominantly male (55.6% vs. 28.4%, p=0.005), and had a larger tumor (7.5 cm vs. 4.2 cm, p<0.001). The median pre-contrast HU was not significantly different between EAML and classic AML ($29.9{\pm}23.7$ vs. $14.7{\pm}41.0$, p=0.071). In multivariable analysis, younger age (odds ratio [OR], 0.96; p=0.032), male sex (OR, 3.33; p=0.013), and tumor larger than 4 cm (OR, 3.8; p=0.009) were significant predictive factors. Five patients (18.5%) had unfavorable outcomes, two patients had lymph node metastasis, and three patients had lung metastasis. Conclusions: Patient and tumor characteristics can be helpful in determining the type of AML preoperatively. Younger age, male sex, and larger tumor mass may increase the possibility of diagnosing EAML. EAML has malignant potential and requires careful follow-up.

Keywords

Acknowledgement

Supported by : Asan Institute for Life Sciences, Ministry of Health & Welfare

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