具有低度恶性潜能的多房囊性肾肿瘤的临床病理特征及预后

doi:10.19723/j.issn.1671-167X.2024.04.019

摘要/Abstract

摘要：

目的: 分析具有低度恶性潜能的多房囊性肾肿瘤(multilocular cystic renal neoplasm of low malignant potential, MCRNLMP)患者的临床病理特征与预后，对比接受不同手术方式的具有低度恶性潜能的多房囊性肾肿瘤患者的临床病理特征。方法: 回顾性收集2010年1月至2023年9月北京大学第三医院收治的行根治性肾切除术或者保留肾单位手术且术后病理明确为具有低度恶性潜能的多房囊性肾肿瘤患者的临床资料，获取其基本临床特征、术后病理结果及预后。根据手术方式将患者分为根治性肾切除术组及保留肾单位手术组，并比较两组患者的临床病理特征差异。结果: 共纳入35例患者，诊断时的中位年龄为53.0(39.0~62.0)岁，其中23例为男性(65.7%)，12例为女性(34.3%)。9例患者接受了根治性肾切除术(25.7%)，26例患者接受了保留肾单位手术(74.3%)。35例患者的临床T分期均未超过T2a期。中位手术时间145.0 min，中位估计术中出血量20.0 mL。术后中位住院天数6.0 d。术后病理结果均未提示肾窦侵犯、肉瘤样变、肾上腺侵犯及淋巴结侵犯。将患者根据手术方式分为保留肾单位手术组和根治性肾切除术组，并对两组的临床病理特征进行对比，差异均无统计学意义。除1例患者失访外，其余患者均获随访，随访时间8~111个月，中位随访时间70.5个月，仅1例患者因非肿瘤原因死亡，其余患者均无肿瘤转移或复发。结论: 具有低度恶性潜能的多房囊性肾肿瘤患者的预后较好; 对于具有低度恶性潜能的多房囊性肾肿瘤，接受保留肾单位手术和根治性肾切除术的患者临床病理学特征差异无统计学意义。

关键词: 肾肿瘤, 保留肾单位手术, 预后

Abstract:

Objective: To analyze the clinicopathological characteristics and prognosis of patients with multilocular cystic renal neoplasm of low malignant potential and compare the clinicopathological characteristics of patients with multilocular cystic renal neoplasm of low malignant potential who underwent different surgical methods. Methods: Clinicopathological data and prognosis of patients admitted to Peking University Third Hospital from January 2010 to September 2023 were collected. Patients who underwent radical nephrectomy or nephron-sparing surgery and were pathologically diagnosed with multilocular cystic renal neoplasm of low malignant potential were identified. Based on the surgical methods, the patients were divided into radical nephrectomy group and nephron-sparing surgery group. The clinicopathological characteristics of the two groups were compared. Results: A total of 35 patients were enrolled in this study. The median age at diagnosis was 53.0 (39.0-62.0) years. Among the 35 patients, 23 were males (65.7%) and 12 were females (34.3%). Nine patients underwent radical nephrectomy (25.7%), while 26 patients underwent nephron-sparing surgery (74.3%). The clinical T-stage of 35 patients did not exceed T2a stage. The median operation time was 145.0 min, and the median estimated intraoperative blood loss was 20.0 mL. The median postoperative hospitalization days was 6.0 d. The postoperative pathological results did not indicate renal sinus invasion, sarcomatous change, adrenal invasion or lymph node invasion. Based on the surgical methods, the patients were divided into a radical nephrectomy group and a nephron-sparing surgery group. There was no significant difference in clinicopathological charac-teristics between the two groups. Except for one patient who was lost to the follow-up, all the other patients were followed up for 8-111 months, with a median follow-up time of 70.5 months. Only one patient died from non-cancer-specific reasons, other patients had no tumor metastasis or recurrence. Conclusion: Patients with multilocular cystic renal neoplasm of low malignant potential have a good prognosis. There is no significant difference in clinicopathological characteristics of patients between nephron-sparing surgery group and radical nephrectomy group for multilocular cystic renal neoplasm of low malignant potential.

Key words: Renal neoplasm, Nephron-sparing surgery, Prognosis

中图分类号:

R737.1

虞乐,邓绍晖,张帆,颜野,叶剑飞,张树栋. 具有低度恶性潜能的多房囊性肾肿瘤的临床病理特征及预后[J]. 北京大学学报（医学版）, 2024, 56(4): 661-666.

Le YU,Shaohui DENG,Fan ZHANG,Ye YAN,Jianfei YE,Shudong ZHANG. Clinicopathological characteristics and prognosis of multilocular cystic renal neoplasm of low malignant potential[J]. Journal of Peking University (Health Sciences), 2024, 56(4): 661-666.

图/表 3

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参考文献 18

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Items	MCRNLMP (n=35)
Age/years, M (P₂₅, P₇₅)	53.0 (39.0, 62.0)
Gender, n (%)
Male	23 (65.7)
Female	12 (34.3)
BMI/(kg/m²), M (P₂₅, P₇₅)	24.5 (22.6, 27.7)
Hypertension, n (%)	14 (40.0)
Diabetes, n (%)	6 (17.1)
History of operation, n (%)	15 (42.9)
Laterality, n (%)
Left	19 (54.3)
Right	16 (45.7)
Tumor diameter/ cm, M (P₂₅, P₇₅)	4.6 (3.7, 7.0)
Clinical T stage, n (%)
T1a	14 (40.0)
T1b	14 (40.0)
T2a	7 (20.0)
Surgical method, n (%)
RN	9 (25.7)
NS	26 (74.3)
Preoperative HGB/(g/L), M (P₂₅, P₇₅)	148.0 (131.0, 154.0)
Preoperative Plt /(g/L), M (P₂₅, P₇₅)	206.0 (172.0, 293.0)
Preoperative WBC count /(×10⁹), M (P₂₅, P₇₅)	5.6 (5.2, 6.6)
Preoperative ALB /(g/L), M (P₂₅, P₇₅)	44.4 (41.5, 46.4)
Preoperative SCr / (μmol/L), M (P₂₅, P₇₅)	80.0 (68.0, 87.0)
Preoperative eGFR/ [mL/(min·1.73 m²)], M (P₂₅, P₇₅)	94.3 (74.1, 118.3)
Operation time/min, M (P₂₅, P₇₅)	145.0 (123.0, 217.0)
Estimated blood loss/mL, M (P₂₅, P₇₅)	20.0 (10.0, 50.0)
Postoperative SCr / (μmol/L), M (P₂₅, P₇₅)	90.0 (80.0, 109.0)
Postoperative eGFR/ [mL/(min·1.73 m²)], M (P₂₅, P₇₅)	82.3 (61.6, 109.5)
Postoperative hospitalization / d, M (P₂₅, P₇₅)	6.0 (5.0, 8.0)
Pathology, n (%)
Sarcomatous change	0 (0)
Lymph node invasion	0 (0)
Adrenal gland invasion	0 (0)
Renal sinus invasion	0 (0)
Postoperative complications, n (%)	9 (25.7)
Serious complications, n (%)	1 (2.9)

Items	NS (n=26)	RN (n=9)	P value
Age/years, M (P₂₅, P₇₅)	53.0 (34.5, 64.3)	51.5 (42.0, 55.5)	0.52
Gender, n (%)			0.64
Male	17 (65.4)	6 (66.7)
Female	9 (34.6)	3 (33.3)
BMI/(kg/m²), M (P₂₅, P₇₅)	24.3 (22.5, 27.4)	24.2 (21.5, 25.8)	0.84
Hypertension, n (%)	8 (30.7)	6 (66.7)	0.11
Diabetes, n (%)	4 (15.4)	2 (22.2)	0.64
History of operation, n (%)	9 (34.6)	6 (66.7)	0.13
Laterality, n (%)			0.99
Left	14 (53.8)	5 (55.6)
Right	12 (46.2)	4 (44.4)
Tumor diameter/ cm, M (P₂₅, P₇₅)	4.3 (3.7, 7.3)	5.3 (3.2, 6.7)	0.22
Clinical T stage, n (%)			0.22
T1a	12 (46.2)	2 (22.2)
T1b	8 (30.8)	6 (66.7)
T2a	6 (23.1)	1 (11.1)
Preoperative HGB/(g/L), M (P₂₅, P₇₅)	147.5 (132.5, 154.8)	140.5 (124.3, 153.3)	0.29
Preoperative Plt/(g/L), M (P₂₅, P₇₅)	207.5 (187.0, 295.0)	210.0 (161.5, 314.0)	0.87
Preoperative WBC count/(×10⁹), M (P₂₅, P₇₅)	5.5 (5.0, 6.6)	6.4 (5.3, 6.6)	0.75
Preoperative ALB/(g/L), M (P₂₅, P₇₅)	45.4 (41.9, 46.7)	43.7 (40.9, 45.5)	0.31
Preoperative SCr/(μmol/L), M (P₂₅, P₇₅)	80.0 (68.3, 87.5)	76.5 (64.3, 96.5)	0.93
Preoperative eGFR/[mL/(min·1.73 m²)], M (P₂₅, P₇₅)	94.2 (79.1, 117.4)	94.3 (54.9, 134.5)	0.78
Operation time/min, M (P₂₅, P₇₅)	134.5 (123.3, 182.5)	212.0 (99.3, 227.8)	0.59
Estimated blood loss/mL, M (P₂₅, P₇₅)	22.5 (10.0, 100.0)	20.0 (15.0, 50.0)	0.57
Postoperative SCr/(μmol/L), M (P₂₅, P₇₅)	82.5 (74.0, 99.3)	115.5 (99.3, 134.8)	0.32
Postoperative eGFR/[mL/(min·1.73 m²)], M (P₂₅, P₇₅)	86.7 (72.8, 109.9)	58.4 (46.2, 84.6)	0.92
Postoperative hospitalization/d, M (P₂₅, P₇₅)	6.0 (5.0, 8.0)	6.0 (4.5, 12.0)	0.57
Postoperative complications, n (%)	7 (26.9)	2 (22.2)	0.99
Serious complications, n (%)	0 (0)	1 (11.1)	0.26