目的: 探讨肾细胞癌合并尿路瘤栓的临床和病理特征。方法: 回顾性分析2015年1月1日至2019年12月31日在北京大学第三医院和首都医科大学附属北京友谊医院住院手术治疗肾细胞癌合并尿路瘤栓患者的基本信息、临床表现、治疗情况、病理特点和随访情况,同时检索文献,将既往报道的此类患者一并列为研究对象。结果: 本研究两家单位共收集到肾细胞癌合并尿路瘤栓患者6例,通过文献检索到16例,共计22例患者,其中男性13例,女性9例,平均年龄54.7岁(22~79岁);左肾15例,右肾6例,病变侧别不明1例;肉眼血尿是最常见的主诉(18例),体质量下降1例,镜下血尿1例,超声检查发现1例,就诊原因不明1例;瘤栓分级为Ⅰ级9例,Ⅱ级10例,Ⅲ级3例;术前诊断肾细胞癌的有11例,术前考虑肾盂癌或不能明确诊断者11例;行肾癌根治性切除术者9例,肾输尿管全长切除术者12例,1例手术方式不明;术后组织病理报告为透明细胞型肾细胞癌15例,乳头状肾细胞癌1例,嫌色细胞癌1例,混合细胞肾细胞癌1例,不能明确分型的肾细胞癌4例;11例患者有随访数据,随访3~31个月,有3例6个月内出现了肺转移。结论: 肾细胞癌合并尿路瘤栓临床上少见,在诊断上需与肾盂癌相鉴别,治疗原则可参照同类型肾细胞癌,对于局部进展期患者,手术完整切除是最佳的治疗方法,患者的肿瘤学预后还有待更长期和更大规模的随访观察。

Objective: To investigate the clinical characteristics, diagnosis and treatment of renal cell carcinoma with urinary tract tumor thrombus. Methods: From January 1, 2015 to December 31, 2019, patients with renal cell carcinoma complicated with urinary tract tumor thrombus who were hospitalized in the Peking University Third Hospital and Beijing Friendship Hospital, Capital Medical University were retrospectively analyzed. Meanwhile, we reviewed the literature, and the reported patients of renal cell carcinoma with urinary tract tumor thrombus were also included in our study. The basic information, clinical manifestations, treatment, pathological characteristics and follow-ups of all the patients were analyzed. Results: In our study, 6 patients from the two hospitals and 16 patients from previous literature reports were included. There were 13 males and 9 females with an average age of 54.7 years (22-79 years). Fifteen patients had renal cell carcinoma on the left side, 6 on the right side, and 1 on the unknown side. Gross hematuria was the most common chief complaint, including 18 patients. One patient complained of weight loss, 1 patient complained of microscopic hematuria, and 1 patient was found by ultrasound examination. Tumor thrombus was classified as grade Ⅰ in 9 cases (the tumor embolus protruded into the renal pelvis, but did not reach the ureteropelvic junction), grade Ⅱ in 10 cases (the tumor embolus protruded into the ureter, but not into the bladder), and grade Ⅲ in 3 cases (the tumor embolus passed through the ureter and protruded into the bladder). Only 11 patients were diagnosed with renal cell carcinoma before operation. Radical nephrectomy was performed in 9 cases and nephroureterectomy in 12 cases. In pathological diagnosis, there were 15 cases of clear cell renal cell carcinoma, 1 case of papillary renal cell carcinoma, 1 case of chromophobe cell carcinoma, 1 case of mixed cell renal cell carcinoma, 4 cases of renal cell carcinoma with undetermined classification. Eleven patients were followed up for 3-31 months, and 3 patients had lung metastasis within 6 months. Conclusion: Renal cell carcinoma with urinary tract tumor thrombus is rare in clinic. It needs to be differentiated from renal pelvis carcinoma in diagnosis. The treatment principle can refer to general renal carcinoma. For locally advanced cases, complete resection is the best treatment, and its oncological prognosis needs more long-term and large-scale follow-up observation.