北京大学学报(医学版) ›› 2014, Vol. 46 ›› Issue (5): 790-793.

• 论著 • 上一篇    下一篇

小肾癌的临床病理特征:单中心1 276例经验总结

杨恺惟,张崔建,李学松△,何志嵩,周利群△   

  1. (北京大学第一医院泌尿外科,北京大学泌尿外科研究所,国家泌尿、男性生殖系肿瘤研究中心,北京100034)
  • 出版日期:2014-10-18 发布日期:2014-10-18

Clinical pathological features of small renal cell cancer: a single-center experience on 1 267 cases

YANG Kai-wei, ZHANG Cui-jian, LI Xue-song△, HE Zhi-song, ZHOU Li-qun△   

  1. (Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China)
  • Online:2014-10-18 Published:2014-10-18

摘要: 目的:研究小肾癌(≤4.0 cm)的临床病理特点。方法:回顾性分析2002年1月至2012年6月间初诊于北京大学第一医院泌尿外科的肾肿瘤患者,记录肿瘤大小、病理亚型、Fuhrman分级(G1~G4)、TNM分期及肿瘤是否存在脉管侵犯、肉瘤样分化、是否具有多灶性,并分组进行比较。结果:共有1 276名患者被纳入研究进行分析,其中306例(24.0%)肿瘤直径≤2.0 cm,526例(41.2%)在2.0~3.0 cm之间,444例(34.8%)>3.0 cm。从病理亚型来看,有1 158例(90.7%)透明细胞癌、49例(3.8%)乳头状癌、32例(2.5%)嫌色细胞癌、33例(2.6%)多房囊性肾细胞癌及4例其他亚型,病理亚型在不同肿瘤直径组间差异无统计学意义。在直径≤2.0 cm组和>2.0 cm组,肿瘤分级为G3/4者分别有15例(4.9%)和98例(10.1%),差异有统计学意义(P=0.007);T3a及以上分期者分别有1例(0.3%)和32例(3.3%),差异亦有统计学意义(P=0.004)。存在同时性远处转移者共6例,均出现在>2.0 cm组,且存在肉瘤样分化、脉管癌栓及多灶性的肿瘤也多见于>2.0 cm组,但两组间差异无统计学意义。结论:小肾癌中直径>2.0 cm者的肿瘤分级、分期与≤2.0 cm者相比有明显差异且更易发生转移,提示对于直径>2.0 cm且影像学显示肾恶性肿瘤者不宜选取非手术干预的治疗策略。

关键词: 癌, 肾细胞, 肿瘤分期, 肿瘤转移, 泌尿外科手术

Abstract: Objective:To study the characteristics of histopathologic features of small renal carcinoma. Methods: This retrospective study collected the data of renal cell carcinoma from the patients who underwent surgery from January 2002 to June 2012. They were all preoperatively diagnosed as renal cancer by CT scan, and pathologically diagnosed as renal cell carcinoma after surgery with the diameter ≤4 cm. We recorded and analyzed the tumor size, histologic subtype, Fuhrman grading, TNM stage, the existence of tumor vascular invasion, sarcomatoid differentiation, and whether it was multifocal, and then grouped them for comparison. Results: A total of 1 276 patients were included in the study and were analyzed, of whom 306 (24.0%) had small renal cell carcinoma less than 2.0 cm, 526 (41.2%) 2.0-3.0 cm, and 444 (34.8%) bigger than 3.0 cm. Of all the subjects, 1 158 (90.7%) suffered from clear cell carcinoma, 49 (3.8%) papillary carcinoma, 32 (2.5%) chromophobe cell carcinoma, whose distribution was not related with tumor size. Of the ≤2.0 cm and >2.0 cm groups, Furmann grades of G3/4 were 15 (4.9%), 98 (10.1%), respectively (P=0.007). T3a+ stage and above were 1 (0.3%), and 32 (3.3%), respectively (P=0.004). Synchronous distant metastases occurred in 6 patients, all in group >2.0 cm. Tumor sarcomatoid differentiation (0.3% vs. 0.9%), vascular invasion (0.6% vs. 2.1%) and multifocal (1.3% vs. 2.7%) had no significant difference between the two groups. Conclusion:Small renal cell carcinoma with diameter over 2.0 cm are more aggressive, suggesting that renal cancer bigger than 2.0 cm in diameter should not select a nonsurgical treatment.

Key words: Carcinoma, renal cell, Neoplasm staging, Neoplasm metastasis, Urologic surgical procedures

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