天津医药

天津医药 ›› 2016, Vol. 44 ›› Issue (6): 748-751.doi: 10.11958/20160127

• 临床研究 • 上一篇    下一篇

高危小肾癌的临床诊治分析

吴育栋 1， 李刚 1， 王江 1， 2， 王勇 1， 牛远杰1   

  1. 1天津医科大学第二医院泌尿外科 （邮编300211）； 2天津市计划生育研究所男性泌尿科
  • 收稿日期:2016-03-08 修回日期:2016-03-28 出版日期:2016-06-15 发布日期:2016-07-04
  • 基金资助:
    国家自然科学基金青年基金项目 （81402094）； 天津市应用基础与前沿技术研究计划项目 （14JCYBJC29800）

Clinical diagnosis and treatment of high-risk small renal cell carcinoma

WU Yudong1， LI Gang1， WANG Jiang1,2， WANG Yong1， NIU Yuanjie1   

  1. 1 Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin 300211, China; 2 Tianjin Municipal Research Institute for Family Planning
  • Received:2016-03-08 Revised:2016-03-28 Published:2016-06-15 Online:2016-07-04

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摘要： 摘要:目的 探讨影响小肾癌不良预后的高危因素， 为个体化治疗提供依据。方法 回顾性分析 2004 年 1 月— 2015 年 7 月天津医科大学第二医院泌尿外科收治的 18 例特殊小肾癌患者的临床病理资料。患者术前均行 B 超、 CT 平扫及增强检查， 并进行手术治疗。分析肿瘤直径、 病理类型、 病理分期、 Fuhrman 分级等因素与患者预后的关系。结果 术前 CT 检查示 18 例患者肿瘤直径 2.0～4.0 cm， 平均 （3.1±0.6） cm。术前诊断 T1aN0M0 分期患者 5 例、 T1aN0M1 患者 4 例（肺转移 3 例、 脑转移 1 例）、 T1aN1M0 患者 3 例（CT 检查均伴有局部淋巴结转移）、 T3aN0M0 患者 6 例 （均有肾静脉侵犯或肾静脉瘤栓）。术后病理示 FuhrmanⅡ级 12 例、 Ⅲ级 5 例、 Ⅳ级 1 例； 透明细胞癌 15 例、乳头状癌 1 例、 混合细胞型 1 例（肾恶性横纹肌样瘤伴肉瘤样变）、 肾肉瘤样癌 1 例（Fuhrman Ⅳ级）。4 例（T3a， FuhrmanⅡ级）行后腹腔镜下肾部分切除术， 其余行后腹腔镜下根治性肾切除术。术后随访 6~48 个月， 中位随访时间 22.5 个月， 死亡 4 例 （2 例初诊肿瘤直径分别为 3.8 cm 及 4.0 cm、 1 例肾肉瘤样癌、 1 例脑转移）， 失访 1 例， 其余患者未见肿瘤复发及转移。结论 小肾癌伴肿瘤直径≥ 3.0 cm、 Fuhrman Ⅲ/Ⅳ级、 肉瘤样癌、 转移等高危因素者为高危小肾癌。高危小肾癌具有异质性， 可表现为侵袭性生长、 早期侵犯肾周组织甚至转移。应根据术前影像学检查结果及术后病理制定个体化治疗方案。

关键词: 肾肿瘤, 诊断, 肿瘤转移, 危险因素, 高危小肾癌

Abstract: Abstract: Objective To investigate the high-risk factors leading to a poor prognosis of small renal cell carcinoma, and provide theoretical basis for the individualized treatment regimen. Methods This retrospective study analyzed the clini⁃ cal and histological data of 18 patients with small renal cell carcinoma treated in the Department of Urology of the Second Hospital of Tianjin Medical University from January 2004 to July 2015. All the patients underwent ultrasound, plain and en⁃ hanced CT examinations, also, received the surgeries. The tumor diameters, pathological types, pathological stages, Fuhrman grading of tumors and the prognosis of patients were analyzed. Results Preoperative CT examination revealed that 18 pa⁃ tients with the average tumor diameter of (3.1 ± 0.6) cm (ranged 2.0 to 4.0 cm). Five patients were diagnosed as T1aN0M0, 4 patients with T1aN0M1 (3 cases with lung metastasis, 1 case with brain metastasis), 3 patients with T1aN1M0 (CT examina⁃ tion showed a lymph node metastasis), 6 patients with T3aN0M0 (renal vein invasion or renal vein tumor thrombus). Patholog⁃ ical examination after surgery showed that 12 patients were Fuhrman grade Ⅱ, 5 were grade Ⅲ and 1 was grade Ⅳ;15 cases were clear cell carcinomas, 1 case was papillary carcinoma, 1 was hybrid cellular tumor (malignant rhabdoid tumor with sar⁃ comatoid differentiation) and the last case was sarcomatoid carcinoma renal cell carcinoma (Fuhrman grade V). 4 patients (T3a, Fuhrman grade Ⅱ) underwent retroperitoneal laparoscopic partial nephrectomy and the remaining underwent laparo⁃ scopic radical nephrectomy. The median follow-up time was 22.5 months (ranged 6 to 48 months). Four cases died (2 cases with tumor diameters of 3.8 cm and 4.0 cm at preliminary diagnosis， 2 cases with sarcomatoid renal carcinoma and 1 with brain metastasis), 1 case was lost. Other patients were found no tumor recurrence and metastasis. Conclusion The small re⁃ nal cell tumor with diameter≥3.0 cm, Fuhrman Ⅲ/Ⅳ grade， sarcomatoid cancer or metastasis should be considered as highrisk factors of small renal cell carcinoma. The high-risk small renal cell carcinoma is heterogeneous in its biological behav⁃ ior, which is expressed as aggressive growth and early invasion of renal tissue and even metastasis. The individualized treatment should be made based on preoperative imaging findings and postoperative pathology.

Key words: kidney neoplasms, diagnosis, neoplasm metastasis, risk factors, high-risk small renal carcinoma