肾细胞癌骨转移的临床与病理分析

doi:10.19723/j.issn.1671-167X.2018.05.008

摘要/Abstract

摘要： 目的：分析肾细胞癌骨转移（renal cell carcinoma bone metastasis，RCC-BM）的临床及病理学特点，进一步了解其发生、发展规律。方法：回顾2003年7月至2017年11月间RCCBM患者的资料，包括患者一般情况，临床与影像学特征，病理学亚型、骨转移灶免疫组织化学染色结果等病理学特征，进行描述性分析和差异性分析。结果：共纳入113例RCC-BM患者进入研究，患者性别比（男 ∶女）约为4 ∶1，平均年龄59.39岁。肾癌骨转移灶影像学均表现为溶骨性破坏，常见的骨转移部位为脊柱（46.0%）及骨盆（38.9%）， 28.3%的RCC-BM患者同时合并其他部位远处转移，46.0%的患者表现为同时性转移［骨转移时间（time to bone metastasis, TTBM）=0］，其余表现为异时性转移（TTBM>0），异时性转移患者的中位TTBM为48个月。113例患者中94.7%为肾透明细胞癌骨转移。对104例患者的骨转移病灶进行免疫组织化学染色检查，同时性RCC-BM患者骨转移灶的血管内皮生长因子（vascular endothelial growth factor，VEGF）阳性率与异时性RCC-BM患者相比有升高趋势（P=0.097），碳酸酐酶（carbo-nic anhydrase, CA）-Ⅸ阳性率有降低趋势（P=0.100）；肾透明细胞癌骨转移灶的表皮生长因子受体（epidermal growth factor receptor, EGFR）阳性率显著高于非透明细胞肾癌的骨转移灶（P<0.05）。结论：RCCBM中男性、中青年患者较多，约80%骨转移发生于脊柱、骨盆等中轴骨部位。不同TTBM亚组间CA-Ⅸ阳性率存在一定差异，可预测RCC-BM预后。VEGF阳性率在同时性RCC-BM亚组中有增高趋势，EGFR阳性率在透明细胞癌亚组中显著增高，可能给RCC-BM的诊断、预后分析、靶向治疗抉择等提供参考。

关键词: 肾细胞癌, 肿瘤转移, 骨, 临床病理学

Abstract: Objective： To analyze the clinical and pathological characteristics of renal cell carcinoma bone metastasis (RCC-BM) patients. Methods: Data of RCC-BM patients from July 2003 to November 2017 were retrospectively reviewed. The patients’ baseline characteristics (age, gender), tumor characteristics ［specific sites of bone metastasis, time to bone metastasis (TTBM), imaging features of bone disease, coexistence of other metastasis］, as well as pathological features (histological classification of primary and bone metastasis, immunohistochemical stain results) were collected. Descriptive analysis and difference analysis were used. Results: A total of 113 RCC-BM patients were enrolled with the gender ratio (male ∶female) of 4 ∶1, mean age of 59.39 years, and all present of osteolysis bone lesions. The common sites of bone metastasis were vertebra (46.0%) and pelvis (38.9%). Other distant metastasis sites coexisted in 28.3%, while 48.18% RCC-BM patients presented with synchronous metastasis (TTBM=0). The median TTBM for metachronous metastasis was 48 months. The majority in this cohort were determined to have primary tumor of clear cell carcinoma. After immunohistochemical examination to 104 RCC-BM patients and sub-group analysis, tendencies of higher positive rates of vascular endothelial growth factor (VEGF) was also found in synchronous group (P=0.097) while tendencies of higher positive rates of carbonic anhydrase (CA)-Ⅸ was found in the same group (P=0.100). The patients with clear cell RCC-BM had a significantly higher positive expression of epithelial growth factor receptor (EGFR, P<0.05) than those with non-clear cell RCC-BM group. Conclusion: More male and younger patients with metastatic lesions in axial skeleton were found in this cohort. Tendencies in the expression of CA-Ⅸ and VEGF in different TTBM sub-group and EGFR in different histology-derived subgroup indicate that they might be associated with risk and prognostic factors and support further target therapies of RCC-BM.

Key words: Renal cell carcinoma, Neoplasm metastasis, Bones, Clinical pathology

中图分类号:

R737.11

黄子雄，杜依青，张晓鹏，刘士军，徐涛. 肾细胞癌骨转移的临床与病理分析[J]. 北京大学学报(医学版), 2018, 50(5): 811-815.

HUANG Zi-xiong, DU Yi-qing, ZHANG Xiao-peng, LIU Shi-jun, XU Tao. Clinical and pathological analysis of renal cell carcinoma bone metastasis[J]. Journal of Peking University(Health Sciences), 2018, 50(5): 811-815.

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